CURRICULUM 


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NURSING 


UNIVERSITY  OF  CALIFORNIA 

AT    LOS  ANGELES 


... 


UNIVERSITY  of  CALIFOKM* 

AT 

LOS  ANGELES 
LIBRARY 


STANDARD  CURRICULUM 

FOR 

SCHOOLS  OF  NUBSIM 

PREPARED  BY 

THE  COMMITTEE  ON  EDUCATION 

OF  THE 

NATIONAL  LEAGUE  OF  NURSING  EDUCATION 
1915  to  1918 


M.  ADELAIDE  NUTTING,  Chairman 
Teachers  College 
New  York  City 

ISABEL  M.  STEWART,  Secretary 
Teachers  College 
New  York  City 

ELLA  PHILLIPS  CRANDALL 
156  Fifth  Avenue 
New  York  City 

MARY  S.  GARDNER 

Providence  District  Nursing 
Association,  Providence,  R.  I. 

ANNIE  W.  GOODRICH 
Teachers  College 
New  York  City 

MARY  C.  WHEELER 

Illinois  Training  School 
Chicago,  111. 

MARY  M.  RIDDLE 
Newton  Hospital 
Newton,  Mass. 


ELSIE  M.  LAWLER 

Johns  Hopkins  Hospital 
Baltimore,  Md. 

MARY  BEARD 

Boston  Inst.  Dist.  Nursing  Asso. 
Boston,  Mass. 

LOUISE  M.  POWELL 


University  Hospital 
Minneapolis,  Minn. 


EDNA  C.  FOLEY 

830  Monroe  Building 
Chicago,  111. 

ELIZABETH  BURGESS 

State  Educational  Department 
Albany,  N.  Y. 

MARY  W.  MCKECHNIE 
420  West  118th  Street 
New  York  City 

SUSAN  E.  TRACY 

818  Center  Street 
Jamaica  Plains,  Mass. 


Copies  may  be  secured  from  the  secretary.    Price  $1.00  with  postage  in  addition 
The  preparation  of  this  curriculum  was  made  possible  by  a  gift  from  Mrs. 
Helen  Hartley  Jenkins  to  meet  the  initial  expenses. 


40154 


COPYRIGHT  1919 
BY  THE  COMMITTEE  ON  EDUCATION 

OP  THE 
NATIONAL  LEAGUE  OF  NURSING  EDUCATION 


COMPOSED  AND  PRINTED  AT  THB 

WAVERLY  PRKS8 

Br  TUB  WlLUAMB  A  WlI.KINS  CouPAWT 

BALTIMORE,  MD.,  U.  8.  A. 


TVPTl 

N^l3s 

13/3 


^- 


TABLE  OF  CONTENTS 

f\ 

I.  Introduction  ......................................................  5 

II.  Relation  of  Hospital  and  Training  School  Organization  and  Admin- 

istration to  the  Curriculum  ..................................  9 

A.  The  General  Purpose,  Character  and  Standing  of  the  Hospital  10 

B.  Form  and  Functions  of  Training  School  Control  ..............  11 

C.  Type  and  Capacity  of  Hospital  ..............................  12 

D.  Financial  Resources  ..........................................  15 

E.  The  Teaching  Field  (Range,  Variety  and  Character  of  Services)  16 

F.  Conditions  of  Life  and  Work  for  Students  (Ratio  of  Nurses  to 
<\  Patients,  Hours  of  Duty,  Housing  and  Living  Conditions, 

etc.)  .......................................................  18 

G.  The  Administrative  and  Teaching  Staff  .....................  22 

H.  Standards  of  Entrance  to  Schools  of  Nursing  .................  24 

I.    The  Admission  of  Classes  ....................................  27 

^-.            J.    Standards  and  Methods  of  Good  Teaching  ....................  27 

—  -             K.  Teaching  Equipment.4.  .......................................  30 

C~)            L.   Records  .....................................................  31 

*""~             M.  University  Affiliations  .......................................  32 

N.  References  on  Nursing  Education  and  Teaching  ..............  32 

III.  Course  of  Study. 

A.  Length  of  Course  and  General  Division  of  Time  .............  35 

B.  General  Scheme  of  Practical  Instruction  ......................  35 

C.  General  Scheme  of  Theoretical  Instruction  ...................  38 

IV.  Outline  of  Subjects. 

A.   Biological  and  Physical  Sciences. 

Anatomy  and  Physiology.  .  .-.  ..............................  40 

Elementary  Bacteriology.  .  i-  ................................  45 

J                        Applied  Chemisty.  .  .  :  ....................  :  .................  48 

I  B.   Household  Science. 

Nutrition  and  Cookery.  .  .  ..................................  53 

Diet  in  Disease.  .:.  .........................................  57 

Hospital  Housekeeping.  k  .*  ..................................  58 

Housekeeping  Problems  of  Industrial  Families.^  ............  60 

C.   Prevention  of  Disease. 

^                       Personal  Hygiene.  .  .•<  ......................................  64 

Public  Sanitation.  .  K  ......................................  67 

p  D.  Treatment  of  Disease. 

Drugs  and  Solutions.  ..T.  ..................................  70 

Materia  Medica  and  Therapeutics.  ^  ........................  72 

Massage.  .-.  ................................................  74 

Special  Therapeutics  (including  Occupation  Therapy)..  ^.  .  .  76 
E.   Nursing  in  Different  Forms  of  Disease. 

Elementary  Nursing  Principles  and  Methods.  .  T  ............  79 

Elementary  Bandaging.  .  *  ..................................  84 

Elements  of  Pathology.  .  .v  ..................................  86 

Nursing  in  Medical  Diseases.  .•  .....  .  .......................  88 

3 


4  TABLE    OF   CONTENTS 

Nursing  in  Surgical  Diseases. .  .• 91 

Nursing  in  Communicable  Diseases. . : 93 

Nursing  in  Diseases  of  Infants  and  Children.  .\ 96 

Gynecological  Nursing  and  Diseases  of  the  Male  Genito- 

Urinary  Tract...; 101 

Orthopedic  Nursing. 103 

Obstetrical  Nursing 105 

Nursing  in  Diseases  of  the  Eye,  Ear,  Nose  and  Throat 109 

Nursing  in  Mental  and  Nervous  Diseases. .  i Ill 

Nursing  in  Occupational,  Skin  and  Venereal  Diseases. . .  K. .  115 

Operating-room  Technic 117 

Emergency  Nursing  and  First  Aid. .  .* 119 

Special  Disease  Problems 121 

F.  Social  and  Professional  Subjects 

History  of  Nursing  (including  Ethical  and  Social  Principles)  123 

Elements  of  Psychology. 130 

«_^.   Principles  of  Ethics —     ^. 131 

Survey  of  the  Nursing  Field.1 137 

Professional  Problems . . .  •. 140 

Modern  Social  Conditions 143 

G.  Special  Branches  of  Nursing. 

Introduction  to  Institutional  Work 147 

Introduction  to  Private  Nursing 149 

Introduction  to  Public  Health  Nursing  and  Social  Service. .   152 

Introduction  to  Laboratory  Work 155 

Appendix   I.     Bibliography   of  Text    and    Reference  Books   Classified 

According  to  Authors,  with  Names  of  Publishers,  prices,  etc 157 

Appendix  II.     List  of  Inexpensive  and  Free  Bulletins,  Pamphlets,  and 

Reports  for  Use  in  Training  Schools 167 

Appendix   III.     List   of   Firms   Supplying   Equipment  and  Illustrative 

Material  for  Training  Schools 169 

Appendix  IV.    Suggestions  of  Physical  Exercises  for  Nurses  in  Training  171 
Appendix  V.    Schemes  of  Practical  Training  for  College  Students  Receiv- 
ing Credit  of  Eight  to  Twelve  Months  for  Satisfactory  Previous 

Work  in  Science 173 

Appendix  VI.     Hour  Schedules  from  Hospitals  in  which  an  Eight-hour 

Day  is  in  Operation 175 

Appendix  VII.     Suggested  Basin  of  Credit  for  Nursing  Schools 177 


INTRODUCTION 

At  the  request  of  the  Council  of  the  National  League  of  Nursing  Education, 
the  Committee  on  Education  undertook  some  little  time  ago  the  task  of  pre- 
paring a  curriculum  which  might  serve  as  a  guide  to  training  schools  struggling 
to  establish  good  standards  of  nursing  education,  and  which  might  also  repre- 
sent to  the  public  and  to  those  who  wish  to  study  our  work,  a  fair  idea  of  what, 
under  our  present  system,  we  conceive  to  be  an  acceptable  training  for  the 
profession  of  nursing. 

In  sending  out  this  curriculum,  the  Committee  desires  to  emphasize  afresh 
its  hope  that  there  will  be  no  failure  to  understand  its  purpose.  It  is  not 
offered  as  a  "model"  curriculum.  There  are  many  improvements  which  we 
would  gladly  introduce  if  we  could  see  any  possibility  of  putting  them  into 
effect  at  the  present  time.  Moreover,  the  Committee  is  not  urging  the  un- 
qualified adoption  of  this  curriculum  in  training  schools  generally.  It  realizes 
that  under  the  widely  varying  conditions  existing  in  hospitals  at  present,  a 
relative  uniformity  only  is  attainable  or  advisable.  Schools  laboring  under 
the  handicap  of  long  hours  and  insufficient  teaching  facilities  would  be  unable 
to  do  justice  to  the  curriculum  here  outlined  until  more  favorable  conditions 
could  be  established.  A  few  schools  with  superior  advantages  and  good  leader- 
ship have  already,  in  certain  respects,  gone  beyond  these  standards  and  it  is 
highly  important  that  they  should  in  no  way  relax  their  efforts,  but  should 
lead  in  working  out  something  better  than  anything  we  have  reached  as  yet. 

The  purpose  which  the  Committee  has  had  in  view,  is  to  arrive  at  some 
general  agreement  as  to  a  desirable  and  workable  standard  whose  main  features 
could  be  accepted  by  training  schools  of  good  standing  throughout  the  country. 
In  this  way  it  is  hoped  that  we  may  be  able  to  gradually  overcome  the  wide 
diversity  of  standards  at  present  existing  in  schools  of  nursing,  and  supply  a 
basis  for  appraising  the  value  of  widely  different  systems  of  nursing  training. 

The  work  of  the  professional  nurse  is  practically  the  same  in  all  the  states 
of  the  union,  and  it  would  seem  to  be  perfectly  evident  that  the  training  which 
is  to  guarantee  a  certain  acceptable  measure  of  competence,  would  need  to 
follow  somewhat  similar  lines,  whether  the  nurse  is  trained  in  California  or 
New  York,  and  whether  the  training  is  given  in  a  small  or  a  large  hospital. 

The  main  difficulty  is  the  lack  of  a  clear  understanding  of  what  the  function 
of  a  modern  nurse  is,  or  what  the  purpose  and  scope  of  her  training  should  be 
The  war  is  making  us  realize,  what  the  public  generally  and  the  training  schools 
have  been  slow  to  recognize,  that  nursing  is  in  a  very  special  sense  a  national 
service,  and  that  the  training  of  the  nurse  is  a  matter  of  vital  concern  not  only 
to  her  hospital  and  to  herself,  but  to  the  country  at  large.  It  is  not  enough 
that  she  should  serve  the  needs  of  a  single  institution  or  of  a  limited  group 
of  people.  She  must  be  ready  to  serve  the  whole  community  and  to  meet 
conditions  as  she  finds  them  in  many  different  kinds  of  communities. 

It  is  becoming  clearly  evident,  that  if  she  is  to  do  this  effectively,  we  must 
revise  many  of  our  old  ideas  about  the  nurses'  training.  The  value  of  her 
service  is  being  recognized  in  so  many  new  fields  of  work,  and  the  character  of 
that  service  is  changing  so  rapidly,  that  the  preparation  which  was  considered 
quite  adequate  a  few  years  ago  is  no  longer  sufficient. 

5 


0  INTRODUCTION 

The  steady  expansion  into  new  and  exacting  fields  of  effort,  .s  continually 
revealing  to  us  both  the  strength  and  the  weakness  of  our  methods  of  training. 
The  strength  lies  in  the  character  of  the  actual  practical  work,  which  in  most 
training  schools  is  sincere  and  thorough  and  performed  in  a  spirit  of  devo- 
tion, zeal  and  self-forgetfulness  which  is  remarkable.  Teachers  and  students 
alike  are  imbued  with  this  spirit.  It  has  become  a  part  of  the  history  and 
tradition  of  nursing  and  forms  an  almost  invaluable  contribution  to  the  world's 
service.  The  weakness  lies  in  the  over-emphasis  placed  upon  the  practical 
aspects  of  the  training  and  the  consequent  neglect  of  the  theoretical  founda- 
tion on  which  really  good  practical  work  must  always  be  built. 

It  is  now  recognized  that  if  the  sick  patient  is  to  have  the  most  skilful  and 
competent  kind  of  nursing  care,  and  if  nurses  are  to  keep  pace  with  the  ad- 
vances of  modern  medicine,  they  must  have  something  more  than  a  mere  deft- 
ness in  precise  manipulations  and  the  scattered  fragments  of  scientific  knowl- 
edge which  are  all  that  can  usually  be  given  in  the  scant  time  allowed  by  most 
hospital  training  schools.  The  development  of  more  highly  complicated  pro- 
cedures in  diagnosis  and  treatment,  and  the  increased  emphasis  especially  on 
dietetic,  hygienic,  occupational  and  mental  factors  in  the  treatment  of  dis- 
ease, make  it  necessary  that  the  nurse  should  assume  an  increasing  measure 
of  responsibility  in  the  care  and  treatment  of  the  patient.  To  safeguard  her 
in  those  responsible  duties,  she  must  have  a  large  measure  of  scientific  knowl- 
edge and  she  must  be  more  highly  trained  both  in  observation  and  in  judgment. 

A  distinct  limitation  in  the  ordinary  training  is  that  it  deals  only  or  mainly 
with  disease,  neglecting  almost  entirely  the  preventive  and  educational  factors 
which  are  such  an  essential  element  in  the  many  new  branches  of  public  health 
work,  such  as  school  and  visiting  nursing,  infant  welfare,  industrial  welfare 
and  hospital  social  service.  Similarly  the  physical  causes  and  evidences  of 
disease  have  been  recognized  as  important,  but  the  social  and  economic  con- 
ditions which  He  at  the  root  of  so  many  of  our  disease  problems,  have  usually 
been  over-looked  in  the  course  of  training.  This  knowledge  is  fundamental, 
particularly  in  the  newer  branches  of  nursing,  and  the  lack  of  it  is  a  distinct 
handicap  to  the  nurse  in  her  work. 

In  positions  of  leadership  especially,  we  are  suffering  for  the  lack  of  well- 
trained  women.  Hospitals  and  training  schools  are  looking  everywhere  for 
competent  women  to  undertake  the  important  duties  of  superintendents, 
supervisors,  teachers  and  technical  experts  in  many  different  departments. 
Unless  the  hospital  itself  selects  good  women  and  gives  them  a  broad  sub- 
stantial foundation  to  begin  with,  there  is  little  hope  that  we  will  develop 
many  of  the  kind  of  leaders  who  are  needed  for  our  very  responsible  educational 
and  administrative  work. 

Nurses  themselves  have  been  the  first  to  realize  the  necessity  for  a  better 
organized  and  more  thorough  course  of  instruction  than  is  commonly  given  in 
the  averge  training  school,  and  they  are  beginning  to  insist  that  they  be 
given  a  kind  of  training  more  commensurate  with  the  tasks  which  are  laid 
upon  them.  It  is  certain  that  we  cannot  command  the  continued  interest  of 
intelligent  and  competent  women  in  hospital  and  nursing  work,  unless  we  can 
provide  a  course  of  study  which  compares  more  favorably  with  the  courses 
given  in  other  technical  and  professional  schools. 


INTRODUCTION  7 

The  members  of  the  Committee  realize  fully  the  difficulties  of  the  hospital 
and  the  training  school  staff  in  meeting  all  these  new  conditions,  with  the 
many  other  perplexing  and  insistent  problems  which  have  to  be  faced.  They 
do  not  for  one  moment  forget  the  invaluable  services  to  nursing  education 
which  have  been  given  at  great  personal  sacrifice  or  in  spite  of  peculiar  ob- 
stacles, by  our  large  body  of  devoted  and  untiring  superintendents  and 
teachers,  and  by  many  physicians  as  well.  Nor  do  they  underestimate  the 
unique  value  of  many  splendid  features  in  our  system  of  training.  They  are 
convinced,  however,  that  the  situation  at  present  demands  an  unusual  effort 
and  they  are  confident  that  training  schools  generally  will  do  their  utmost  to 
at  least  approximate  these  standards  of  nursing  education  which  have  been 
agreed  upon  as  reasonable  and  desirable.  They  believe  that  the  public  and 
the  pupil  nurse  are  justified  in  expecting  this  effort  from  all  hospital  training 
schools,  but  particularly  from  those  claiming  to  rank  as  nursing  schools  of  the 
better  class. 

The  Committee  wishes  to  make  it  quite  clear  that  while  it  believes  all  the 
subjects  suggested  in  the  course  of  study  are  important,  they  are  not  all  equally 
important.  It  will  be  noted  that  several  of  the  subjects  outlined  are  recom- 
mended only,  and  it  is  understood  that  they  should  not  be  introduced  at  the 
sacrifice  of  the  more  fundamental  subjects.  In  suggesting  some  elective  sub- 
jects, the  Committee  does  not  wish*  to  advocate  specialization  within  the 
general  training,  but  only  an  opportunity  for  students  to  get  a  fair  introduc- 
tion to  one  of  the  fields  of  nursing  in  which  they  are  specially  interested. 

The  general  feeling  of  most  of  those  who  have  gone  over  the  outlines  is  that 
while  the  material  is  all  necessary,  and  they  would  be  unwilling  to  have  any 
of  it  eliminated,  the  time  usually  allotted  is  too  short  to  cover  the  ground  in  a 
really  thorough  way.  The  Committee  has  decided  to  leave  the  material  as  it 
is,  with  the  suggestion  that  the  hours  should  be  increased  wherever  possible, 
and  that  instructors  should  use  their  own  discretion  in  choosing  what  points 
should  be  particularly  stressed  and  which  should  be  omitted  or  treated  less 
thoroughly. 

The  work  has  proven  much  more  difficult  than  at  first  anticipated,  especially 
since  the  members  of  the  Committee  are  all  women  already  fully  occupied 
with  exacting  professional  duties  which  the  pressing  problems  of  the  last  year 
or  two  have  greatly  increased.  After  the  general  scheme  was  decided  upon 
by  the  Committee  and  approved  by  the  League  of  Nursing  Education,  the 
various  subjects  were  assigned  to  members  specially  qualified  in  those 
branches,  who  proceeded  with  such  help  and  advice  as  they  were  able  to 
secure,  to  work  out  the  outlines  according  to  a  general  form.  Each  outline 
was  then  multigraphed  and  copies  were  submitted  to  a  number  of  representa- 
tive training  school  superintendents,  teachers,  supervisors  and  public  health 
nurses  throughout  the  country  for  detailed  criticisms  and  suggestions.  Over 
one  hundred  members  have  assisted  in  this  work.  The  outlines  were  then 
collected,  the  suggestions  compiled  and  new  outlines  made  out  which  were 
again,  in  several  cases,  referred  back  to  various  members 'before  being  finally 
approved.  Opinions  differed  frequently  and  in  such  cases  the  majority 
opinion  was  accepted.  A  great  many  helpful  suggestions  were  received,  and 


8  INTRODUCTION 

the  Committee  takes  this  opportunity  of  again  thanking  all  those  friends  who 
so  generously  assisted  in  the  work. 

There  is  little  doubt  that  the  next  few  years  will  see  many  new  developments 
along  nursing  lines.  It  is  the  intention  of  the  Committee  to  keep  the  curricu- 
lum up-to-date  by  frequent  revision,  and  to  supplement  the  material  in  this 
first  edition  from  time  to  time.  The  Committee  begs  the  assistance  of  all 
those  who  are  interested  in  the  better  training  of  nurses,  in  this  work.  We 
should  be  particularly  grateful  to  have  any  suggestions  for  additions  or  cor- 
rections which  should  be  made  in  the  next  edition. 


THE  RELATION  OF  HOSPITAL  AND  TRAINING 
SCHOOL   ORGANIZATION  AND  ADMINIS- 
TRATION TO  THE  CURRICULUM 

In  working  out  a  curriculum  which  aims  to  cover  the  ground  required  in  the 
training  of  nurses  in  so  satisfactory  a  way  that  it  can  be  accepted  as  a  standard 
and  adopted  generally  in  training  schools,  certain  important  facts  must  be 
kept  steadily  in  mind.     These  are,  first,  that  the  education  of  nurses  is  notv 
carried  on  in  the  ordinary  type  of  school,  but  in  hospitals  and  under  a  well- 
established  system  which  requires  that  the  practical  training  shall  be  obtained 
through  student  service  in  the  various  departments.     This  practical  training  * 
•'ndeed,  is  considered  of  such  importance  in  the  general  scheme  as  to  occupy 
almost  the  entire  time  and  energy  of  the  student;  in  all  schools  of  which  we 
have  knowledge  more  than  nine-tenths  of  the  student's  time  throughout  the 
three  years  being  devoted  to  practical  work.    This  means  that  the  theory,,' 
essential  and  indispensable  as  it  is,  in  reality  occupies  everywhere  a  relatively' 
small  place  in  respect  to  time  in  the  curriculum.     It  means  also  that  the  con- 
ditions in  the  hospital  under  which  the  teaching  and  training  are  conducted  and 
under  which  the  students  live  and  work,  are  decisive  factors  in  the  situation. 

A  curriculum  does  not  operate  itself.  It  is  dependent  upon  persons  and 
conditions  to  give  it  life.  No  matter  how  admirably  planned,  it  can  only  be 
made  truly  effective  in  the  education  of  the  nurse  if  the  hospital  in  which  it  is 
to  be  carried  out  is  of  proper  character  and  standing,  and  provides  in  its  clinical 
resources,  teaching  facilities  and  administrative  policy,  a  suitable  field  for  the 
training  of  nurses.  It  has  seemed  necessary,  therefore,  at  the  outset,  to  try 
to  show  what  the  general  conditions  and  main  requirements  in  hospitals  should 
be  in  order  to  ensure  the  satisfactory  working  out  of  a  good  curriculum. 

This  is  a  peculiarly  difficult  thing  to  do,  because  of  the  vastness  and  com- 
plexity of  the  hospital  field.  There  are  about  as  many  types  of  hospitals  as 
there  are  specialties  in  medicine.  They  exhibit  extreme  variation  in  purpose, 
scope  of  work,  size,  and  also  in  form  of  administration,  ranging  from  that 
exercised  by  municipal  authorities  or  responsible  bodies  of  trustees  to  that  of 
commercial  stock  companies  or  of  individual  enterprise.  How  shall  we  judge 
of  the  ability  of  any  one  of  these  hospitals  to  provide  a  suitable  field  for  the 
training  of  nurses,  or  of  its  fitness  to  undertake  that  important  task?  What 
standards  and  tests  can  we  apply?  For  it  is  evident  that  many  hospitals  are 
unable  to  provide  for  the  most  fundamental  requirements  in  any  form  of 
worthy  educational  work. 

The  standards  which  the  Committee  has  accepted  as  desirable  and  here 
presents  in  outline  are  those  which  have  been  gradually  developed  through 
the  experience  and  experiment  of  nurses  who  have  been  long  engaged  in 
hospital  and  training  school  work,  and  in  serious  and  continuous  study  of  the 
administrative  and  educational  problems  involved.  In  the  course  of  years 
certain  conditions  and  requirements  have  been  found  to  be  essential  to  the 
conduct  of  a  good  and  sound  system  of  training  school  work.  These  condi- 
tions which  have  so  important  a  bearing  upon  the  situation,  are  found  through- 

9 


10  HOSPITAL   AND   TRAINING   SCHOOL   STANDARDS 

out  the  entire  structure  of  hospital  life,  from  foundation  and  purpose  to  inti- 
mate daily  conduct  of  affairs.  They  may  in  the  main  be  summed  up  in  a 
general  way  under  the  following  headings: 

A.  The  General  Purpose,  Character  and  Standing  of  the  Hospital. 

B.  Form  and  Functions  of  Training  School  Control. 

C.  Type  and  Capacity  of  Hospital. 

D.  Financial  Resources. 

E.  The  Teaching  Field  (Range,  Variety  and  Character  of  Services). 

F.  Conditions  of  Life  and  Work  for  Students.     (Ratio  of  Nurses  to  Patients, 
Hours  of  Duty.     Housing  and  Living  Conditions.)  " 

G.  The  Administrative  and  Teaching  Staff. 

H.  Standards  of  Entrance  to  Schools  of  Nursing. 

I.  The  Admission  of  Classes, 

J.  Standards  and  Methods  of  Good  Teaching. 

K.  Teaching  Equipment. 

L.  Records. 

M.  University  Affiliations. 

A.  THE  GENERAL  PURPOSE,  CHARACTER  AND  STANDING  OF  THE 

HOSPITAL 

The  first  and  one  of  the  most  fundamental  requirements  is  that  the  hospital 
shall  be  of  good  standing  in  the  community,  that  it  shall  be  under  the  general 
direction  of  a  responsible  body  of  persons,  trustees,  directors,  or  managers  of 
such  weight  and  influence  &*  to  establish  beyond  question,  the  purpose,  dignity 
and  stability  of  the  institution,  and  to  afford  guarantees  to  the  public,  and  to 
prospective  students  and  their  families  in  particular,  that  it  is  a  suitable  place 
to  which  to  invite  young  women  to  enter  for  serious  professional  training.  In 
other  words  it  must  show  that  it  is  both  able  and  ready  to  meet  its  obligations. 

The  character  and  standing  of  a  hospital  in  any  community  must  have  a 
direct  bearing  upon  the  kind  of  teaching  which  it  will  offer.  A  hospital  of 
established  reputation  will  select  with  great  care  its  officers  and  staff,  physi- 
cians, nurses,  and  all  others  concerned  in  the  care  of  the  sick,  and  will  exact 
from  them  a  high  quality  of  work,  and  single-minded  devotion  to  the  interests 
and  welfare  of  the  patients.  If  it  does  not  its  reputation  cannot  be  maintained. 
The  standards  of  its  own  work  will  be  projected  into  its  teaching  throughout, 
and  its  teaching  will  be  of  two  kinds, — the  conscious,  deliberate  and  formal,  and 
the  unconscious  and  incidental.  Not  more  surely  by  what  the  student  is  told 
ought  to  be  done,  than  by  what  she  sees  done  daily,  will  her  ideals  in  work  be 
shaped.  That  hospital,  then,  in  which  the  teaching  and  training  of  nurses  can 
best  be  carried  on,  is  of  a  character  which  commands  public  confidence  and 
respect  not  only  through  the  sound  scientific  nature  of  its  work,  but  through 
its  ethical  and  altruistic  purpose.  Its  whole  life  will  be  permeated  by  the  best 
spirit  and  traditions  of  medicine  and  nursing. 

B.  FORM  AND  FUNCTIONS  OF  TRAINING  SCHOOL  CONTROL 

If  the  training  school  for  nurses  were  simply  the  nursing  staff  of  the  hospital 
and  nothing  more,  then  it  could  be  placed  upon  the  same  basis  as  other  hospital 


HOSPITAL  AND  TRAINING   SCHOOL   STANDARDS  11 

departments  and  dealt  with  accordingly.  But  in  just  such  degree  as  the  school 
is  something  more  than  the  nursing  staff,  outside  and  beyond  it,  do  new  and 
different  considerations  enter  into  its  management.  Many  elements  which  the 
training  school  brings  into  hospital  affairs  do  not  naturally  fall  into  any  part 
of  the  administrative  scheme  of  an  institution  for  the  care  of  the  sick.  Quite 
alien  to  the  general  purpose  and  usual  activities  of  the  hospital,  are  the  special 
and  somewhat  intricate  problems  of  education  to  which  the  training  school 
must  give  constant  time  and  attention,  or  fail  in  its  work.  And  because  these 
problems  are  different,  dealing  with  matters  outside  of  hospitals  which  must 
be  viewed  from  other  angles  besides  those  looking  to  efficient  hospital  adminis- 
tration, it  is  essential  that  there  should  be  some  body  of  persons  who  are  very 
specially  concerned  with  them.  A  good  many  hospitals  are  now  providing  for 
this  need  by  the  appointment  of  training  school  committees,  and  it  is  the 
opinion  of  almost  all  training  school  superintendents  who  have  carried  on  their 
work  with  and  without  such  committees,  that  they  are  an  almost  indispensable 
factor  in  a  good  organization. 

The  composition  of  such  a  body  varies  in  different  institutions,  but  it  is 
suggested  that  a  good  working  committee  appointed  from  the  trustees  of  the 
hospital  might  be  composed  of  five  persons,  which  should  include  two  Trustees, 
a  member  of  the  Medical  Board,  the  Superintendent  of  the  Hospital,  and  the 
Superintendent  of  the  Training  School.  Such  a  committee  would  usually  be 
greatly  strengthened  by  the  addition  of  some  one  engaged  in  educational  work, 
such  as  the  Superintendent  of  Public  Schools,  or  the  Dean,  or  Director  of  a 
good  College,  Normal,  or  Technical  School.  In  connection  with  large  city 
hospitals,  into  the  government  of  which  city  politics  sometimes  enter,  a 
separate  board  of  women  managers  has  been  found  to  be  a  great  support  and 
protection  to  the  training  school. 

The  functions  of  these  committees  would  naturally  vary  under  different 
conditions,  but  in  the  main  they  would  consist  in  studying  the  needs  of  the 
school  as  an  educational  institution  not  purely  concerned  with  the  temporary 
service  of  the  hospital,  but  with  the  permanent  service  of  the  public,  and  in 
establishing  such  equitable  relationships  between  the  hospital  and  training 
school,  and  such  conditions  of  student  life  and  work  as  will  bring  this  result. 
They  should  see  that  suitable  requirements  for  admission  are  established  and 
maintained;  that  sound  educational  standards,  for  both  practical  and  theo- 
retical work  prevail;  that  there  is  a  properly  qualified  administrative  and 
teaching  staff;  that  it  is  supplied  with  adequate  school  equipment  and  teach- 
ing material;  and  that  proper  regulations  are  made  about  such  matters  as 
tuition  fees,  loan  funds,  and  scholarships. 

Since  these  are  all  fundamentals  which  are  well  recognized  in  every  school, 
it  is  certain  that  ways  and  means  must  be  found  of  providing  them.  It  will 
therefore  be  the  function  of  the  Committee  to  prepare  a  budget,  and  to  secure 
adequate  appropriations  from  the  hospital  and  from  other  sources,  to  place  the 
school  upon  this  dignified,  secure  and  stable  basis,  and  to  ensure  it  that  inde- 
pendence in  its  work  and  freedom  for  proper  growth  and  development  which 
are  characteristics  of  any  good  educational  system  and  which  a  satisfactory 
financial  status  alone  can  give.  The  securing  and  distribution  of  funds  for  the 
maintenance  of  the  school  may  be  one  of  the  most  important  functions  of  a 


12  HOSPITAL  AND  TRAINING  SCHOOL  STANDARDS 

training  school  committee  in  fostering  good  standards  and  ideals  in  the  work 
of  the  school. 

C.  TYPE  AND  CAPACITY  OF  HOSPITAL 

The  type  of  hospital  in  which  a  training  school  can  best  be  established  is  that 
which  provides  the  requisite  number  of  patients  and  variety  of  services  of  a 
suitable  character.  It  has  long  been  accepted  that  the  general  hospital,  in 
which  all  the  more  common  forms  of  medical  and  surgical  diseases  are  treated 
and  which  admits  men  and  women  patients,  best  answers  to  this  description. 
General  hospitals  under  municipal  government  or  private  endowment  or  main- 
tained by  contributions  are  found  in  all  large  cities,  in  most  moderate  s  zed 
and  in  many  small  cities. 

The  actual  number  of  beds  and  daily  average  of  patients,  within  certain 
specified  limits,  is  of  less  importance  than  the  variety  and  character  of  the 
services.  The  very  large  municipal  hospitals  of  from  600  beds  up  to  1000  or 
1500,  usually  offer  the  richest  possible  field  for  training,  in  so  far  as  numbers 
and  variety  and  character  of  services  are  concerned,  and  in  the  exceptional 
opportunities  afforded  by  their  clinics  and  dispensaries.  The  great  difficulty 
here  lies  in  securing  enough  expert  supervisors,  and  qualified  instructors,  and 
enough  in  the  way  of  resources  and  conveniences  to  maintain  a  good  quality  of 
work  over  such  a  vast  area.  The  problem  of  training  is  difficult  because  of  the 
almost  unwieldy  dimensions  of  the  training  field,  and  of  the  enormous  bulk  of 
work  to  be  done.  In  such  large  city  hospitals  this  problem  may  also  some- 
times be  complicated  by  the  fact  that  there  may  be  a  division,  sometimes  a 
large  one,  of  patients  with  chronic  diseases  providing  little  in  the  way  of  suit- 
able opportunity  for  training,  yet  requiring,  under  the  system,  a  definite  place 
in  the  general  scheme  of  instruction.  Granted,  however,  means  to  maintain 
a  sufficiently  large  staff  of  graduate  nurses  in  addition  to  the  student  nursing 
service,  and  a  liberal  and  properly  qualified  staff  of  executive  officers,  super- 
visors and  teachers,  a  great  municipal  hospital  affords  a  wonderful  teaching 
field. 

On  the  other  hand,  very  small  hospitals,  even  when  general  in  character, 
have  definite  limitations  not  only  in  numbers  of  patients,  and  in  range  and 
variety  of  disease,  but  also  in  equipment  and  facilities.  The  opportunities 
they  offer  for  observation  and  training  and  their  resources  are  usually,  in  the 
very  nature  of  the  case,  too  meagre  and  restricted  to  provide  more  than  a 
fraction  of  the  required  course  of  instruction  in  nursing.  While  these  very 
small  hospitals  are  obviously  unable,  in  most  instances,  to  provide  a  satis- 
factory field  for  the  entire  training  of  nurses,  they  are  the  class  of  institutions 
frequently  most  needing  the  assistance,  which  a  training  school  provides. 
Their  problem  is  a  difficult  one.  Probably  most  of  them  could  supply  good 
practical  training  in  the  care  of  patients  suffering  from  a  few  of  the  more  com- 
mon forms  of  disease  for  a  period,  let  us  say,  covering  not  more  at  the  extreme 
than  12  months.  How  to  secure  the  necessary  instruction  in  theory  is,  how- 
ever, another  question.  There  does  not  appear  to  be  any  other  way  to  get  the 
elementary  scientific  groundwork  required  in  nursing  than  to  turn  to  the 
visiting  teacher,  who  might  spend  two  days  weekly  in  three  not  too  widely 


HOSPITAL  AND   TRAINING   SCHOOL   STANDARDS  13 

separated  hospitals,  or  to  fall  back  upon  the  nearest  high  school  for  special 
classes,  or  upon  a  combination  of  both,  with  assistance  from  local  physicians. 
The  success  of  such  plans  would  depend  greatly  upon  the  energy  and  initiative 
of  the  head  of  the  training  school,  and  upon  her  ability  to  make  the  utmost 
possible  use  of  every  available  opportunity.  It  takes  women  of  exceptionally 
good  professional  training,  experience  and  resourcefulness  to  bring  forth 
satisfactory  results  from  a  poor  field. 

Given  well-trained  assistance  in  the  hospital,  and  the  certainty  of  a  good 
quality  of  practical  training,  there  appears  to  be  no  reason  why  at  leas  tone 
year  of  prescribed  ground  could  not  be  covered  and  the  students  passed  on  to 
the  larger  schools  to  complete  their  training.  Small  schools  should  be  as  proud 
of  sending  up  their  students  to  certain  large  hospitals  for  the  final  two  years, 
as  preparatory  schools  are  of  sending  theirs  to  colleges.  The  principle  is  the 
same.  The  necessity  of  a  uniform  arrangement  of  subjects  is  clear,  for  the 
larger  school  must  know  just  what  ground  in  theory  and  practice  has  already 
been  covered,  and  must  require  that  certain  well-defined  work  has  been  done. 

Between  these  two  extremes  lie  a  large  number  of  hospitals  capable  of  pro- 
viding excellent  teaching  fields.  In  the  order  of  their  capacity  in  this  direction 
they  would  stand  about  as  follows :  first,  hospitals,  general  in  character,  and 
under  municipal  or  private  government,  with  from  400  to  500  beds,  and  having 
not  only  the  four  main  services — medical,  surgical,  children's  and  obstetric — 
but  certain  of  the  special  branches,  such  as  nervous  and  mental  disorders, 
contagious  diseases,  eye,  ear,  throat  and  nose,  etc.  These  afford  a  practically 
complete  field  for  the  training  of  nurses.  There  can  be  no  question  of  their 
ability  under  proper  administration  to  conduct  training  schools  of  the  very 
highest  character.  Next  would  come  hospitals  of  the  same  general  type  and 
character,  with  from  150  to  200  beds,  and  a  daily  average  of  from  125  to  150 
patients.  These  also  provide  excellent  teaching  fields. 

While  the  smaller  general  hospitals  can  only  meet  the  requirements  and 
obligations  which  the  establishment  of  schools  of  nursing  imposes  on  them  by 
acquiring  suitable  affiliations  with  other  hospitals  able  to  provide  satisfactory 
instruction  and  training  in  the  branches  of  nursing  in  which  they  are  deficient, 
it  is  pretty  generally  agreed  that  unless  such  hospitals  have  a  daily  average  of 
about  50  patients  and  a  fairly  acute  service,  it  is  hardly  possible  for  them  to 
maintain  schools  of  nursing  of  the  usually  accepted  standards.  This  appears 
to  be  about  the  minimum,  in  so  far  as  the  number  of  patients  is  concerned,  and 
has  been  long  accepted  as  such  in  England  and  various  other  countries,  and  by 
the  American  Red  Cross  in  this  country.  In  the  training  of  medical  students, 
the  Council  of  Education  of  the  American  Medical  Association  urges  that  hos- 
pitals, to  be  satisfactory  for  teaching  purposes,  should  have  a  daily  average  of 
not  less  than  200  patients  who  can  be  utilized  for  clinical  teaching.  (See 
Journal  American  Medical  Association,  August  19,  1916,  pages  601-607.) 

There  must  be  variations  from  these  suggested  standards  in  exceptional 
institutions,  and  particularly  in  certain  states  and  sections  where  hospitals 
have  developed  slowly  and  are  almost  all  quite  small.  They  are  all  that  is 
available  for  training  purposes  in  such  localities,  and  obviously  the  standards 
that  are  desirable  in  older  communities  where  work  is  further  advanced,  cannot 
and  should  not  be  applied  to  them  at  present. 


14  HOSPITAL   AND   TRAINING   SCHOOL   STANDARDS 

Special  hospitals  present  a  peculiar  problem.  Many  of  them  can  contribute 
to  the  general  scheme  of  training,  and  efforts  should  be  made  to  utilize  the 
special  opportunities  they  provide.  Few,  if  any  of  them,  are  competent  to 
conduct  schools  in  which  the  main  portion  of  the  work  lies  entirely  outside 
their  interests  or  activities.  That  they  can  cooperate  largely,  however,  in 
educational  work  is  clear,  as  more  and  more  the  special  branches  which  they 
represent  become  incorporated  into  the  regular  accepted  plan  or  scheme  of 
training.  Such  subjects  as  obstetrics,  and  children's  diseases  are  now  com- 
monly required,  and  it  seems  probable  that  for  public  health  work,  training 
in  contagious  diseases,  and  possible  in  mental  and  nervous  disorders  may  be 
called  for. 

Special  hospitals  form  numerically  a  very  large  group.  They  are  often 
large,  well  equipped  and  carefully  administered,  and  they  are  not  infrequently 
well  endowed  and  able  to  secure  the  best  specialists  in  the  branches  they  repre- 
sent to  direct  their  work.  The  nursing  in  such  hospitals  is  carried  on  in  sev- 
eral ways — by  the  employment  of  a  trained  graduate  staff  of  nurses,  by  post- 
graduate courses,  by  affiliations  with  regular  training  schools,  by  maintaining 
regular  schools  of  nursing  or,  in  the  cases  of  hospitals  for  the  insane,  of  schools 
for  the  training  both  of  nurses  and  attendants.  The  organization  of  this  very 
large  and  valuable  field  of  training  still  remains  to  be  adequately  worked  out 
but  in  the  main  it  seems  fairly  obvious  that  such  hospitals  can  perform  a  better 
service  by  making  their  ownspecal  contribution  to  the  training  of  nurses,  than 
by  conducting  regular  schools  of  nursing.  ,  Just  because  they  are  engaged  in  a 
special  branch  of  work,  it  is  practically  certain  that  their  whole  energy  will 
be  thrown  into  efforts  to  make  this  branch  still  more  highly  and  perfectly 
specialized. 

For  this  reason  there  is  some  genuine  ground  for  question  as  to  the  ability 
of  such  institutions  to  conduct  schools  of  nursing  professing  to  offer  complete 
general  training.  The  main  portion  of  the  student's  full  period  of  training  is 
spent  working  among  patients  rightly  grouped  in  a  special  class.  This  may 
occupy  two  full  years  or  even  more,  ou.t  of  the  three,  while  in  all  accepted 
schemes  for  a  satisfactory  arrangement  of  work,  this  same  specialty  would 
seldom  be  given  more  than  six  months  of  time  at  the  most.  In  addition  to 
this,  the  full  emphasis  must  of  necessity  be  laid  upon  that  particular  branch. 
The  impressions  made  upon  the  student's  mind  are  in  relation  to  a  particular 
type  and  condition — this  is  inescapable.  The  provision  which  is  made  for  train- 
ing in  general  nursing  (or  for  all  other  branches)  will  be  comparatively  small, 
and  relatively  all  out  of  proportion  in  a  sound  scheme  of  training,  and,  further, 
the  order  of  things  is  reversed,  and  the  special  is  made  to  precede  the  general 
and  fundamental. 

The  more  important  special  hospitals  are  those  dealing  with  obstetrics,  men- 
tal and  nervous,  contagious,  and  children's  diseases.  Children's  depart- 
ments are  now  increasingly  found  in  general  hospitals,  and  there  appears  to 
be  also  an  increase  in  the  number  of  obstetrical  wards.  It  is  noticeable  that 
maternity  hospitals  in  most  instances  affiliate  and  offer  three  or  four  months 
of  special  training,  to  be  included  in  the  regular  work  of  the  student  nurse.  A 
few  offer  post-graduate  work  also.  Contagious  hospitals  occasionally  affiliate, 
but  they  appear  more  frequently  to  employ  salaried  graduate  nurses  varied 


HOSPITAL  AND  TRAINING  SCHOOL  STANDARDS  15 

with  occasional  post-graduate  work.  Hospitals  for  the  insane  and  for  children 
more  commonly  establish  regular  schools  and  require  that  the  bulk  of  the 
student's  training  shall  be  received  in  the  single  special  field  represented. 

The  question  of  affiliations  is  a  matter  of  extreme  importance  in  making  up 
a  proper  curriculum  for  pupil  nurses.  It  is  important  to  ascertain  just  what 
any  possible  affiliation  has  to  offer,  and  how  long  should  be  given  to  it  in  a  well- 
balanced  curriculum.  The  parent  school  should  feel  itself  strictly  responsible 
for  the  standards  both  of  practical  and  theoretical  work  in  the  affiliating 
school,  and  should  see  to  it  that  proper  conditions  of  life  and  work  and  proper 
guardianship  are  assured. 

Efforts  should  be  steadily  made  to  bring  about  a  better  system  of  adjustment 
and  to  see  that  training  in  special  branches  follows  upon  a  general  groundwork. 
This  could  usually  be  easily  done  where  the  training  school  is  under  university 
direction,  and  a  unifying  and  coordinating  power  can  thus  be  provided.  In 
every  such  special  branch  provision  should  be  made  for  two  types  of  students 
— those  who  need  some  training  in  it  as  a  part  of  a  general  course  and  those  who 
are  choosing  it  as  a  field  of  special  work.  A  longer  period  of  training  is  neces- 
sary for  the  specialist. 

Hospitals  and  sanitaria  under  private  ownership  cannot  be  recommended  as 
suitable  institutions  to  assume  the  direction  of  training  schools  for  nurses. 
Their  purposes  are  frankly  commercial,  and  under  such  government  the  exploi- 
tation of  pupil  nurses  is  practically  impossible  to  control.  The  maintenance 
of  satisfactory  standards  of  teaching,  of  work,  or  of  student-life,  may  be 
assumed  to  be  outside  of  their  purposes  and  possibilities. 

No  attempt  has  been  made  in  this  study  to  consider  the  very  important  ques- 
tion of  post-graduate  education  for  nurses.  It  may  be  said  in  passing,  however, 
that  the  same  general  principles  which  have  been  laid  down  for  the  training 
of  pupil  nurses,  apply  to  the  courses  for  graduate  nurses  which  are  offered  by 
hospitals.  The  graduate  student  should  have  a  curriculum  especially  ar- 
ranged to  meet  her  needs,  and  every  facility  should  be  given  her  so  that  she 
may  profit  to  the  full  by  both  her  class  work  and  her  ward  experience.  Most 
graduate  students  would  be  willing  to  pay  for  the  kind  of  instruction  they 
need,  on  the  condition  that  they  should  be  released  from  the  long  hours  of 
exacting  ward  work,  and  should  have  the  advantage  of  expert  teaching  and 
supervision. 

D.  FINANCIAL  RESOURCES 

Schools  of  nursing  at  present  everywhere  rest  upon  an  unsound  and  pre- 
carious financial  basis.  None  of  them  are  endowed,  none  are  maintained  by 
public  funds — none,  in  fact,  have  any  real  resources  whatever  for  the  conduct 
of  their  work  beyond  the  provision  which  the  hospital  (whose  nursing  services 
the  school  is  supplying)  is  able  and  willing  to  make.  Most  hospitals  find  it 
hard  to  get  enough  funds  to  keep  their  work  going  on  a  satisfactory  basis. 
They  cannot  contribute  to  the  support  of  schools — on  the  contrary,  they  must 
use  the  school  to  help  support  the  hospital.  A  few  hospitals  may  have  some 
means  available,  but  as  a  rule  their  conception  of  the  function  of  their  train- 
ing schools  is  so  imperfect  as  to  prevent  serious  consideration  of  their  needs 
from  a  financial  standpoint.  There  is  a  slight  awakening  of  interest  in  this 


16  HOSPITAL   AND   TRAINING   SCHOOL   STANDARDS 

aspect  of  affairs,  but  until  it  has  taken  a  real  hold  on  the  minds  of  those  re- 
sponsible for  the  conduct  of  hospitals,  and  consequently  of  training  schools  for 
nurses,  until  there  is  a  wider  understanding  of  the  vital  importance  to  society 
of  the  work  which  nurses  are  doing,  there  can  be  little  hope  that  schools  of 
nursing  can  be  maintained  upon  a  truly  satisfactory  economic  basis,  or 
can  render  their  full  measure  of  usefulness  to  the  public. 

The  hospital,  under  certain  conditions,  can  provide  largely  of  the  main  essen- 
tials. Its  wards  form  the  indispensable  laboratories  for  training  in  nursing; 
its  life  and  disciplines  are  of  incomparable  value  in  such  training,  but  equally 
necessary  in  any  adequate  system  are  bodies  of  trained  teachers  and  suitable 
places  in  which  to  teach;  lecture,  and  class  rooms,  laboratories,  libraries,  and 
other  teaching  equipment  and  material,  scientific  and  technical.  Equally 
important  are  suitable  conditions  of  student  life  and  work.  These  costs  of 
education  can  never  be  neglected. 

The  ordinary  needs  for  the  proper  conduct  of  the  training  school  should  be 
considered  carefully  in  the  making  up  of  the  hospital  budget.  The  head  of  the 
school  should  be  required  to  present  an  estimate  of  the  probable  expenses  of  her 
department,  which  should  include  provision  for  necessary  developments  in  any 
desirable  direction. 

Where  it  is  impossible  for  the  hospital  to  supply  the  necessary  funds, there 
should  be  no  hesitation  in  making  direct  appeals  to  private  individuals  or 
associations,  or,  in  certain  cases,  in  asking  for  appropriations  from  public 
funds  for  the  proper  financial  support  of  the  school.  No  school  of  nursing  can 
hope  to  carry  on  and  develop  its  work  satisfactorily  without  such  support. 

E.  THE  TEACHING  FIELD  (RANGE,  VARIETY  AND  CHARACTER  OF 

SERVICES) 

It  is  commonly  accepted  that  a  good  teaching  field  must  provide  satisfactory 
opportunities  for  training  in  the  four  main  branches  of  nursing — medical, 
surgical,  obstetrical  and  children — and  that  the  services  must  be  reasonably 
acute.  Generally  speaking,  the  value  of  any  service  from  the  standpoint  of 
training,  is  directly  proportionate  to  the  number  of  acute  cases  being  cared 
for.  Chronic  and  convalescent  cases  are  of  limited  value  as  teaching  material, 
though  they  call  for  certain  special  kinds  of  care,  certain  personal  qualities, 
and  adaptations  which  should  have  a  definite  place  in  the  scheme  of  instruc- 
tion. The  degree  of  acuteness  may  be  measured  by  the  number  of  admissions 
per  bed  per  year.  A  service  in  which  the  number  of  admissions  per  bed  per 
year  averages  from  16  to  20  or  over,  is  an  acute  service.  Below  8  per  bed  per 
year,  it  would  rank  as  an  inactive  service,  and  the  diseases  would  probably  be 
sub-acute  or  chronic  in  character. 

It  must  be  recognized  that  the  experience  in  medical  wards  particularly 
varies  greatly  at  different  seasons  of  the  year,  offering  excellent  material  for 
study  and  nursing  care  during  the  pneumonia  and  typhoid  seasons  especially 
but  at  certain  other  times  giving  little  opportunity  for  observation  and  spe- 
cial treatment.  Efforts  should  be  made  by  supervisors  and  instructors  to  see 
that  if  possible,  students  whose  experience  in  a  given  department  has  been 
relatively  uninstructive,  should  have  an  opportunity  of  supplementary  train- 


HOSPITAL   AND   TRAINING   SCHOOL   STANDARDS  17 

ing  later.  In  any  case  class  teaching  and  ward  clinics  should  help  in  making 
up  any  possible  weakness  in  practical  experience.  In  each  service  the  com- 
moner varieties  of  cases  should  be  found  and  when  unusual  forms  of  disease 
are  admitted,  the  opportunity  for  observation  and  instruction  which  they 
present,  should  always  be  utilized  as  far  as  practicable  for  the  benefit  of  all 
student  nurses. 

From  the  standpoint  of  teaching,  a  large  and  active  private  service  in  a 
hospital  presents  difficulties.  It  makes  excessive  demands  upon  the  time  of 
administrative  and  supervisory  staff,  and  occupies  a  relatively  large  place  in 
the  general  scheme  of  training.  Furthermore  it  is  a  distinct  loss  to  the  stu- 
dent, in  that  it  substitutes  the  restricted  experience  of  service  with  one  or 
two  individuals,  for  the  varied  and  instructive  opportunities  provided  by  the 
many  patients  of  the  large  open  ward.  It  cannot  be  assumed  that  a  student 
who  is  assigned  to  the  care  of  from  one  to  three  patients  during  a  given  period 
can  learn  as  much  as  during  a  similar  period  where  from  thirty  to  forty  patients 
may  be  under  her  observation  and  care. 

The  advantages  to  be  derived  from  service  in  private  wards  are  small  in 
comparison  and  quite  special  in  nature.  Undue  emphasis  has  been  placed 
upon  the  value  of  this  service,  which,  in  the  interests  of  good  teaching,  should 
be  kept  at  a  reasonable  minimum.  There  is  a  difference  in  equipment  and  in 
some  details  of  service  for  such  patients,  but  there  can  be  no  difference  in  the 
nursing,  and  it  is  of  the  utmost  importance  that  this  point  shall  never  be  lost 
sight  of.  Standards  and  methods  of  nursing  are  the  same,  and  special  cases 
require  special  nursing,  quite  irrespective  of  their  place  in  the  hospital  or  their 
ability  to  pay.  The  large,  open  public  ward  is  the  ideal  training  ground  for 
student  nurses.  It  has  been  suggested  that  the  ratio  of  private  to  free  patients 
should  not  exceed  one  to  four  in  teaching  hospitals. 

A  complete  medical  service  should  provide  training  in  the  care  of  all  the 
usual  medical  diseases,  and  also  in  the  nursing  of  communicable  diseases. 
So  important,  indeed,  is  this  in  the  preparation  of  nurses  for  modern  public 
health  work,  that  it  is  difficult  to  see  how  they  can  get  along  without  it. 
Affiliations  should  be  sought  which  would  provide  this  training  in  the  acute 
infectious  diseases  for  those  particularly  needing  it,  even  where  it  is  not 
required  or  obtainable  for  the  entire  student  body.  Facilities  for  training 
in  the  care  of  nervous  and  mental  patients  should  also  be  made  available. 

The  surgical  service  should  provide  training  in  the  care  of  all  the  ordinary 
surgical  diseases,  and  should  include  gynecology,  orthopedics,  operating-room 
work,  and  training  in  that  department  in  which  accidents,  emergencies,  and 
minor  surgical  matters  are  handled — whether  this  be  in  a  special  ward  or 
dispensary. 

It  is  desirable  that  the  obstetrical  service  be  sufficiently  large  and  active  to 
ensure  a  proper  training  within  a  reasonable  period.  Probably  the  measure 
of  training  here  should  be  determined  by  the  number  of  cases,  rather  than  by 
the  number  of  weeks. 

The  children's  service  should  .provide  opportunity  for  the  observation  and 
handling  of  sick  children  not  only  in  infancy,  but  up  through  the  years  of 
childhood..  It  is  one  of  the  most  important  of  all  the  services,  and  with  the 
development  of  public  health  work,  and  the  widespread  introduction  of  nurses 


18  HOSPITAL   AND   TRAINING    SCHOOL   STANDARDS 

into  public  schools,  it  has  become  fundamental  and  indispensable  in  the  scheme 
of  training. 

The  dispensary  or  outdoor  service  provides  invaluable  opportunities  for 
instruction.  Patients  visiting  dispensaries  for  advice  or  diagnosis  present 
many  conditions  and  states  of  disease  rarely  seen  in  the  wards.  The  greater 
the  number  of  cases  in  each  division  under  close  and  continued  observation 
and  treatment,  the  more  profitable  the  instruction  to  the  student  nurse.  It 
may  precede  or  follow  her  training  in  the  wards.  Probably  a  period  of  service 
in  the  early  stage  of  training  and  again  at  a  later  stage,  would  prove  of  most 
genuine  educational  value  though  it  might  be  difficult  to  work  out.  Fre- 
quenty  a  hospital  will  have  a  pretty  well-developed  dispensary  or  clinic  for 
which  it  has  no  corresponding  hospital  service.  This  would  perhaps  be  par- 
ticularly true  of  such  special  services  as  eye  and  ear,  throat  and  nose,  and  skin 
diseases  which  are  of  special  importance  to  those  intending  to  enter  public 
health  work.  The  dispensary  should  play  a  much  larger  part  in  the  training 
of  the  nurse  than  it  has  hitherto  usually  done,  and  its  special  resources  should 
be  as  completely  utilized  as  possible.  As  a  partial  preparation  for  almost  any 
form  of  public  health  work,  it  is  of  unquestionable  value,  and  if  it  has  a  social 
service  bureau,  with  follow-up  work  in  the  homes,  its  powers  in  this  direction 
are  greatly  enlarged. 

Where  the  hospital  is  used  as  a  teaching  ground  for  medical  students  or  as  a 
field  for  medical  research,  the  value  of  the  service  to  the  student  nurses  is 
usually  increased  in  certain  ways.  They  work  in  an  atmosphere  of  scientific 
inquiry  and  must  frequently  assist  in  experimental  work;  and  they  share  in  a 
measure  in  the  instruction  which  goes  on  continually.  In  some  departments 
of  work,  however,  there  may  be  a  distinct  loss  to  student  nurses,  as  for  instance 
when  much  of  the  required  assistance  in  operating-rooms,  dressing-rooms,  etc., 
is  taken  over  by  the  medical  students. 

F.  CONDITIONS  OF  LIFE  AND  WORK  FOR  STUDENTS 

Ratio  of  Nurses  to  Patients 

The  ratio  of  student  nurses  to  patients  cannot  be  worked  out  on  any  basis 
which  is  capable  of  general  application,  because  of  the  many  and  various 
factors  entering  into  the  situation.  It  is  affected  by  the  number  and  variety 
of  services ;  by  the  character  of  these  services — that  is,  whether  they  are  acute, 
sub-acute  or  largely  chronic  in  nature;  by  the  proportion  of  private  patients; 
by  the  plan  and  arrangement  of  the  hospital  (small  wards  always  requiring 
a  relatively  larger  service  than  large  wards);  and  also  in  some  degree  by  the 
number  of  orderlies  and  other  helpers  of  various  kinds  provided.  A  teaching 
hospital  where  many  clinics  are  held,  and  where  medical  students  need  to  be 
looked  after  and  helped,  requires  a  larger  staff  of  student  nurses.  There  is  a 
difference  in  the  number  of  student  nurses  required  in  a  medical  and  in  a 
surgical  ward  of  the  same  size,  and  a  wide  difference,  usually,  between  these 
and  the  number  called  for  in  children's,  maternity,  infectious,  or  in  mental 
wards.  The  operating-room  offers  a  special  problem  contingent  upon  the 
number  of  operations  daily.  The  dispensary  and  clinics  must  be  governed  by 
similar  conditions. 


HOSPITAL  AND  TRAINING   SCHOOL  STANDARDS  19 

The  general  opinion  appears  to  place  the  ratio,  at  present,  of  student  nurses 
to  patients  in  an  active  service  about  as  follows : 
Free  ward  service 

Day  duty 1  nurse  to  5  patients 

Night  duty 1  nurse  to  10  patients 

Private  ward  service 

Day  duty 1  nurse  to  3  patients 

Night  duty 1  nurse  to  5  patients 

This  is  the  minimum  ratio,  it  is  believed,  which  can  be  accepted  as  likely, 
under  the  usual  conditions,  to  enable  the  school  to  maintain  satisfactory 
standards  of  work  and  teaching. 

Hours  of  Duty 

In  the  last  analysis,  the  pivot  upon  which  the  whole  curriculum  swings,  is 
the  system  of  hours  of  duty  which  the  hospital  requires  of  the  nursing  staff. 
The  very  purpose  of  the  instruction  for  which  the  student  pays  by  her  service, 
is  frustrated  by  long  hours.  Good  teaching — any  teaching,  in  fact — is  wasted 
on  students  who  have  been  engaged  in  prolonged,  heavy,  physical  effort,  or  in 
exacting  forms  of  nursing  which  involve  considerable  mental  and  nervous 
strain.  The  senses  are  dulled,  the  mind  works  more  slowly,  concentration  is 
practically  impossible,  wrong  impressions  are  frequently  carried  away,  but 
worse  than  all  of  these  is  the  fact  that  the  student  acquires  a  distaste  for  the 
work  which  is  made  too  difficult  for  her  to  accomplish  creditably.  The  fact 
is  that  long  hours  of  work  for  student  nurses  have  been  for  a  quarter  of  a  cen- 
tury the  greatest  stumbling  block  to  progress  in  nursing.  The  whole  experi- 
ence of  that  period  goes  to  show  unmistakably  that  an  adequate  body  of 
instruction  cannot  be  established  by  training  schools,  unless  at  the  same  time 
a  system  of  hours  is  arranged  which  permits  the  students  to  accomplish  the 
required  study  satisfactorily  and  without  detriment  to  health  and  spirit. 

But  even  if  we  do  not  consider  the  educational  work  which  as  a  rule  has  been 
carried  on  outside  of  the  required  number  of  hours  of  duty  on  the  wards,  the 
nine-  to  ten-hour  working  day,  the  twelve-hour  night  and  the  seven-day  week, 
still  required  in  most  hospitals,  would  generally  be  considered  excessive  from 
the  standpoint  of  health  and  efficiency  alone,  even  for  laboring  men.  It  is 
strange  that  hospitals  have  been  so  slow  in  grasping  and  applying  the  findings 
of  science  on  the  subject  of  fatigue.  The  eight-hour  day  has  been  so  generally 
accepted  as  the  maximum  for  a  normal,  healthy  life,  especially  under  condi- 
tions demanding  physical  effort  and  mental  strain,  and  it  has  been  enforced  by 
law  in  so  many  departments  of  the  world's  work,  even  under  the  unusual 
demands  of  war,  that  the  hospital  lays  itself  open  to  peculiarly  unfavorable 
comparisons  by  its  continued  insistence  on  a  policy  which  has  been  discredited 
not  only  by  scientific  and  educational  authorities,  but  by  frankly  commercial 
enterprises  as  well. 

The  long  hours  of  night  duty  are  particularly  grave  in  their  effects  upon  the 
student's  capacity  to  reap  proper  advantage  from  her  instruction.  Night 
duty  in  itself,  under  any  conditions,  is  disturbing  to  the  maintenance  of  a  good 
system  of  instruction,  in  that  each  time  the  student  is  placed  on  night  work 
there  is  a  temporary  new  adjustment  of  habits  of  daily  life.  But  any  person 


20  HOSPITAL  AND   TRAINING   SCHOOL  STANDARDS 

who  has  performed  twelve  hours  of  work  such  as  is  required  almost  universally 
on  night  duty,  should  be  looked  upon  as  incapable  of  further  effort — mental 
or  physical.  Any  kind  of  satisfactory  educational  work  is  made  practically 
impossible  for  such  hours. 

Training  schools  for  nurses  should  be  scrupulously  sensitive  in  seeing  that 
the  instruction  they  offer  is  given  under  conditions  which  will  in  no  way  lessen 
or  impair  its  value.  It  is  necessary  to  be  constantly  watchful  on  this  point, 
because  the  needs  of  the  hospital  are  imperative  and  difficult  to  satisfy,  and 
power  and  control  are  centered  there.  The  head  of  the  training  school  is  fre- 
quently all  that  stands  between  the  students  and  the  urgent  demands  of  the 
hospital  for  a  larger  service  than  can  safely  be  required  of  them.  Her  vigi- 
lance, courage,  and  sense  of  justice  may  be  their  sole  protection  against  con- 
ditions of  life  and  work  which  would  render  of  little  value  the  best  quality  of 
actual  instruction  which  could  be  offered. 

Although  under  the  present  system  of  education  in  nursing,  tuition  fees  are 
not  required  from  students,  a  very  exacting  form  of  student  service  is  required. 
While,  up  to  a  certain  point,  we  may  look  upon  this  service  as  indispensable  in 
our  method  of  training,  we  should  not  forget  that  it  is  always  of  distinct  and 
substantial  financial  value  to  the  hospital  and  that  through  it  the  student  pays 
the  equivalent  of  the  most  ample  tuition  fees,  and  also  pays  for  everything 
else  which  the  hospital  provides  her. 

In  so  far  as  hours  of  work  for  pupil  nurses  are  concerned,  there  is  general 
agreement  that  eight  hours  of  practical  work  per  day  is  the  maximum  which 
can  be  required  in  a  satisfactory  scheme  of  training.  The  findings  of  the  Com- 
mittee, the  opinion  of  heads  of  training  schools,  and  the  experience  of  those 
familiar  with  the  system  coincide  in  approving  the  eight-hour  schedule,  and  in 
urging  its  adoption.  They  recommend  that  one  afternoon  of  6  hours  per  week 
be  allowed,  making  a  total  of  54  hours  a  week  for  practical  work.  Those  who 
have  tried  this  system  would  not  be  willing  to  go  back  to  the  old,  realizing  that 
not  only  is  the  actual  nursing  care  of  the  patients  of  better  quality,  but  that 
good  teaching  becomes  possible  in  the  shorter  day.  Furthermore,  it  has  been 
shown  that  shorter  hours  and  better  teaching  inevitably  attract  more  and 
better  qualified  candidates  to  the  school. 

The  change  from  a  nine-  or  ten-hour  day  to  an  eight-hour  day  will  necessarily 
call  for  an  increase  in  the  number  of  student  nurses,  and  here  one  is  met  at 
once  by  the  lack  of  adequate  housing  accommodations,  which  is  an  almost 
chronic  condition  in  our  rapidly  growing  hospital  field.  One  solution  of  the 
problem  may  perhaps  lie  in  the  adoption  of  the  plan  now  being  tried  out  in  a 
few  hospitals  of  arranging  for  those  students  who  have  good  homes  in  the  com- 
munity to  live  at  home.  A  somewhat  different  adjustment  of  hours  makes  this 
a  practicable  scheme,  and  it  would  provide  a  substantial  increase  in  staff  with- 
out additional  expenditure  for  quarters  and  maintenance.  The  principle  has 
for  years  been  applied  in  arrangements  for  the  service  of  special  nurses  in  pri- 
vate wards  of  hospitals  and  here  it  works  out  satisfactorily. 

Housing  and  Living  Conditions 

It  is  hardly  possible  to  overestimate  the  importance  of  the  conditions  under 
which  student  nurses  live.  Next  to  hours  of  work  these  form  the  factors 


HOSPITAL  AND   TRAINING  SCHOOL  STANDARDS  21 

affecting  most  deeply  their  health,  spirit,  and  general  power  to  handle  their 
work  efficiently  or  to  derive  benefit  from  the  instruction  and  training  which  is 
virtually  offered  in  part  payment  for  their  services. 

Among  the  essentials  which  should  be  provided  in  students'  residences  are 
single  rooms  for  all  students.  Double  rooms  should  only  be  used  when  abso- 
lutely unavoidable  and  should  be  looked  upon  as  a  temporary  and  undesirable 
expedient.  Student  nurses  receive  their  training  under  peculiarly  difficult 
and  exacting  conditions,  and  are  subject  to  certain  strains  and  to  responsi- 
bilities quite  unlike  those  which  students  in  any  other  profession  whatever 
have  to  meet.  They  need,  when  off  duty,  the  quiet  and  privacy  of  individual 
rooms  — they  need  it  for  rest  and  most  particularly  for  study.  These  rooms 
should  be  comfortable,  with  good  beds.  They  should  be  supplied  with  writ- 
ing tables  and  shelves  for  books  and  papers.  Pupils  should  always  have  good 
lights  to  study  by,  since  most  of  their  study  must  be  carried  on  in  the  evening. 
There  should  be  such  provision  made  for  personal  clothing  and  other  necessi- 
ties a\s  will  enable  the  student  to  keep  her  belongings  in  good  order.  The 
standards  of  living  for  the  student  must  be  such  as  she  will  be  expected  to 
apply  in  the  homes  and  institutions  in  which  she  works  and  teaches.  These 
standards  include  the  maintenance  of  orderly  and  hygienic  surroundings,  and 
immaculate  personal  cleanliness.  The  lavatories  should  provide  ample  facili- 
ties for  this  and  not  less  than  one  bath  room  for  six  students  is  looked  upon 
as  meeting  modern  requirements. 

The  dietary  should  be  especially  adapted  to  students  engaged  in  arduous 
work  involving  physical  as  well  as  mental  strain,  and  such  disruption  of  normal 
life  as  night  duty  or  special  duty  usually  brings.  No  body  of  persons  in  the 
hospital  needs  more  careful  consideration  on  this  point  than  the  staff  of  student 
nurses.  There  should  be  a  carefully  worked  out  menu,  the  food  should  be  well 
selected,  well  cooked  and  attractively  served. 

Suitable  quarters  should  be  provided  for  students  on  night  duty,  to  ensure 
protection  from  noise  and  other  disturbances.  The  whole  atmosphere  of  the 
nurses'  home  or  dormitory  should  be  one  of  quiet  comfort  and  refinement. 
There  should  be  suitable  reception  and  sitting  rooms  and  such  service  as  is 
necessary  in  maintaining  a  dignified,  orderly,  attractive  and  homelike 
household. 

A  number  of  schools  are  now  employing  social  directors,  or  house  mothers, 
to  look  after  those  aspects  of  the  students'  home  life  which  the  superintendent 
and  staff  cannot  possibly  give  much  attention  to,  owing  to  their  other  en- 
grossing duties.  Definite  provision  is  thus  made  for  a  wholesome  and  stimu- 
lating social  life  in  the  home,  and  for  the  introduction  of  outside  interests 
which  the  pupil  nurse  particularly  needs. 

Fees  and  Allowances.    Scholarships 

It  has  long  been  the  practice  of  hospitals  to  make  a  money  allowance  to 
pupils  of  from  four  up  to  fifteen  dollars  per  month,  to  cover  expenses  of  uni- 
form, text-books  and  other  incidentals  connected  with  their  work.  An  in- 
creasing number  of  representative  hospitals  are  giving  up  this  practice,  and 
are  devoting  the  funds  so  released,  to  building  up  their  educational  system 


22  HOSPITAL   AND   TRAINING   SCHOOL   STANDARDS 

through  better  teaching  and  supervision,  shorter  hours  of  hospital  work  and 
better  living  conditions. 

Several  schools  have  gone  farther  than  this  and  are  requiring  a  tuition  fee 
of  from  $25  to  $50  or  more  for  the  preparatory  period  of  training,  and  at  least 
one  regular  school  of  nursing  requires  tuition  fees  for  the  entire  course  of 
training.  A  tuition  fee  for  the  preparatory  term  is  a  just  charge  in  those 
instances  where  practically  the  entire  time  of  students  is  spent  in  class  and 
practice  work  which  requires  the  employment  of  several  special  teachers 
and  supervisors.  This  fee  is  sometimes  returned  on  the  completion  of  the 
training.  It  should  not  be  charged  where  any  considerable  proportion  of  the 
students'  time  in  this  preliminary  period  is  spent  in  the  hospital.  It  should 
be  understood  that  the  fee  will  not  be  returned  to  those  students  who  do  not 
remain  after  the  preparatory  term. 

There  is  no  doubt  that  the  tendency  at  present  is  toward  the  payment  of 
tuition  fees.  Where  this  policy  has  been  introduced  and  has  been  accompanied 
by  a  radical  improvement  in  the  course  of  study  and  the  introduction  of  other 
features  making  for  high  standards  of  training,  such  as  reasonable  hours  and 
good  living  conditions,  the  result  has  always  been  to  increase  rather  than 
decrease  the  number  of  eligible  applicants,  and  to  definitely  improve  the  class 
of  women  entering  the  school.  It  is  useless  to  introduce  tuition  fees  unless 
these  conditions  are  assured. 

There  is  little  use  made  of  scholarships  in  schools  of  nursing.  A  few  leading 
schools  award  them,  but  usually  at  the  close  of  the  full  term  of  training,  to  a 
student  desiring  further  study  in  some  special  branch.  There  might  well  be 
a  wider  use  of  scholarships,  and  they  might  be  offered  to  exceptionally  well- 
qualified  candidates  who  desire  to  secure  training  in  nursing  but  are  unable 
to  incur  even  the  modest  personal  expenses  which  are  usually  a'l  that  student 
nurses  are  required  to  meet.  Provision  for  such  candidates  is  made  in  vir- 
tually all  other  educational  institutions,  and  schools  of  nursing  might  through 
the  adoption  of  this  policy  find  a  way  of  admitting  some  unusually  desirable 
candidates. 

G.  THE  ADMINISTRATIVE  AND  TEACHING  STAFF  (FACULTY  OF 

THE  SCHOOL) 

The  requirements  here  may  be  briefly  indicated  by  calling  attention  to  the 
double  functions  of  practically  all  training  school  officers.  They  are  respon- 
sible for  the  whole  scheme  of  instruction  and  training,  which  is  essentially  an 
educational  function;  and  they  are  also  responsible  for  the  efficient  adminis- 
tration and  supervision  of  the  nursing  service  of  the  hospital  and  frequently  of 
the  housekeeping  service  as  well,  which  are  administrative  functions. 

The  administrative  and  teaching  staff  of  the  school  (sometimes  called  the 
faculty)  must  generally  include  the  following  persons: 

a.  A  superintendent  or  director  of  nurses,  who  is  also  the  principal  of  the 

school. 

b.  Assistant  (one  or  more,  in  accordance  with  the  size  of  the  hospital  and 

school,  and  the  character  and  dimensions  of  the  work). 


HOSPITAL  AND  TRAINING  SCHOOL  STANDARDS         23 

c.  Instructor  (one  or  more,  as  needed). 

d.  Graduate   nurses   as   heads   of   all   departments    (medical,    surgical, 

children's,  maternity,  dispensary,  operating-room,  etc.). 

e.  Night  superintendent  (with  such  graduate  assistants  as  may  be  needed). 

f.  Dietitian  (and  assistants  as  needed). 

g.  In  addition  there  should  be  a  carefully  selected  and  paid  staff  of  lec- 

turers in  all  the  general  medical  and  special  subjects. 

It  is  hardly  necessary  to  say  that  the  woman  who  is  to  direct  the  education 
and  training  of  nurses,  and  to  direct  also  the  nursing  service  of  a  hospital,  even 
of  moderate  size  and  under  the  least  exacting  conditions,  must  be  herself  an 
educated  woman.  It  is  not  enough  that  she  should  be  a  well-trained  nurse 
with  varied  experience  and  also  a  reliable  and  trustworthy  woman.  These 
two  considerations  are  indispensable.  Nor  is  she  to  be  considered  qualified 
because  she  is  a  good  business  manager.  Details  of  office  management  and 
ward  supervision  can  be  delegated  to  assistants,  but  the  superintendent  of 
nurses  must  herself  be  able  to  plan  and  direct  the  work  of  the  school  and  must 
be  able  to  coordinate  it  with  the  work  of  the  hospital.  She  must  under- 
stand people  and  be  able  to  secure  their  cooperation,  and  she  must  have  that 
kind  of  personality  and  judgment  which  will  command  the  confidence  and 
respect  of  her  associates.  It  is  imperative  that  the  director  of  a  school  of 
nursing  which  undertakes  to  prepare  young  women  for  one  of  the  most  impor- 
tant of  modern  professions,  should  have  a  sound  educational  background  and 
a  broad  point  of  view,  so  that  she  will  be  able  not  only  to  maintain  satis- 
factorily already  established  standards,  but  to  work  out  new  methods  and 
new  educational  policies  in  accordance  with  the  needs  of  the  times. 

As  far  as  is  practicable,  a  similar  kind  of  education,  of  training,  and  of  per- 
sonal qualities  should  be  required  of  assistants  and  graduate  heads  of  depart- 
ments. In  addition  to  purely  executive  duties,  they  will  all  have  to  supervise 
and  criticize  the  work  of  students  and  in  many  instances  to  assist  actively  in 
the  regular  teaching.  It  is  desirable  that  as  far  as  practicable,  the  heads  of 
special  departments  should  be  prepared  to  teach  the  branches  they  represent. 

In  most  schools  it  will  be  necessary  to  employ  at  least  one  regular  instructor 
who  will  be  more  directly  responsible  for  the  teaching  of  the  younger  nurses. 
She  will  usually  be  expected  to  teach  the  elementary  sciences  as  well  as  the 
fundamental  principles  and  technic  of  nursing. 

To  hold  the  interest  of  pupils  and  to  stimulate  them  to  their  best  efforts, 
both  in  their  theoretical  and  practical  work,  the  instructor  needs  to  have  a 
strong  and  vigorous  personality  and  a  fund  of  real  enthusiasm  for  her  work. 
She  should  be  approachable  and  helpful  in  dealing  with  pupils,  but  at  the  same 
time  should  show  a  reasonable  degree  of  firmness  and  decision  in  keeping  them 
up  to  a  good  standard  of  work.  No  one  should  attempt  to  teach  who  has  not  a 
fairly  keen,  well-balanced  and  well-ordered  mind,  a  real  love  for  study  and  a 
strong  desire  to  help  young  nurses  to  enjoy  their  work  and  get  the  most  out  of 
their  training. 

The  instructor  should  know  thoroughly  the  subjects  she  is  to  teach.  It  is 
not  possible  to  make  this  knowledge  exhaustive,  but  it  should  be  authoritative 
and  up-to-date,  and  always  well  in  advance  of  her  class.  She  must  be  con- 


24  HOSPITAL   AND   TRAINING    SCHOOL   STANDARDS 

« 

stantly  refreshing  and  supplementing  her  knowledge  by  study  and  observation, 
or  her  work  will  inevitably  suffer.  The  teacher  must  also  have  a  wide  practical 
experience  in  the  branches  she  teaches,  and  should  be  expert  in  demonstrating 
practical  procedures. 

In  addition  to  sound  technical  and  professional  training,  some  experience 
and  training  in  teaching  is  almost  essential.  Fortunately  many  nurses  have 
had  Normal  School  preparation  and  have  taught  in  elementary  or  high  schools, 
but  most  of  those  who  plan  to  teach  in  training  schools  will  need  to  take  special 
courses,  both  to  increase  their  knowledge  of  their  subjects  and  to  help  them  to 
teach  more  effectively. 

As  far  as  possible,  all  those  who  are  concerned  with  the  teaching  work  of  the 
school  should  have  these  personal  and  professional  qualifications.  For  all  the 
special  branches,  such  as  dietetics,  massage,  pathology,  etc.,  specialists  will  be 
needed,  and  though  it  is  perhaps  of  first  importance  that  they  should  be  experts 
in  those  branches,  this  in  itself  would  be  of  small  value  without  the  ability  to 
"get  the  subject  over"  to  the  pupils.  Physicians  should  be  employed  for  all 
subjects  dealing  with  the  actual  study  and  treatment  of  disease,  such  as  sur- 
gery, obstetrics,  etc.,  and  they  should  be  specialists  in  those  branches,  so  far 
as  possible.  In  each  of  these  subjects,  however,  there  are  demonstrations  and 
discussions  of  nursing  treatment  and  technic  which  are  better  handled  by 
nurses.  As  far  as  possible,  the  supervisors  who  have  charge  of  the  practical 
training  in  these  special  departments  should  be  responsible  for  the  nursing 
classes  and  quizzes  which  supplement  the  doctor's  lectures  on  the  various 
special  branches. 

All  good  teaching  requires  time  for  preparation,  and  this  should  always  be 
allowed  for,  as  well  as  the  correcting  of  note-books  and  the  other  routine  work 
entailed  in  all  branches  of  teaching.  The  instructor  whose  whole  time  is 
given  to  teaching  should  not  be  expected  to  give  more  than  from  four  to  five 
hours  daily  in  actual  class-room  work,  and  she  should  be  completely  set  free 
from  all  routine  executive  duties  of  the  hospital  which  have  little  or  no  relation 
to  teaching  work. 

While  it  is  important  that  the  number  of  persons  on  the  administrative  staff 
should  be  sufficient  for  the  demands  of  the  work,  its  real  strength  must  be 
determined  not  by  numbers,  but  by  the  preparation  and  the  personal  qualities 
which  each  member  contributes.  It  is  practically  impossible  to  conduct  a 
good  school  without  a  well-qualified  body  of  officers  and  teachers,  all  working 
together  in  the  interests  of  students,  and  of  the  people  whom  these  students 
are  ultimately  destined  to  serve. 

H.  STANDARDS  OF  ENTRANCE  TO  SCHOOLS  OF  NURSING 

Education 

Schools  of  nursing  in  good  standing  should  require  all  applicants  to  present 
evidence  of  graduation  from  a  four-year  high  school,  private  school  or  other 
secondary  institution  of  approved  standards,  or  to  provide  satisfactory 
credentials  from  responsible  school  authorities  showing  that  they  have  re- 
ceived the  equivalent  of  high  school  training.  In  every  case  the  fundamental 


HOSPITAL   AND   TRAINING   SCHOOL   STANDARDS  25 

subjects,  such  as  high  school  English,  history,  mathematics,  and  science  must 
have  been  thoroughly  covered.  In  most  good  high  schools  the  study  of  Latin 
or  one  modern  language  is  also  required  for  graduation.  Training  school 
officers  should  be  provided  with  the  lists  of  accredited  high  schools,  and  in  any 
case  of  doubt  should  investigate  the  standing  of  the  school. 

Where  it  is  impossible  at  once  to  require  full  high  school  standing,  two  years 
is  suggested  as  a  temporary  minimum,  with  approved  and  certified  courses  in 
English,  mathematics,  history,  and  elementary  science.  Any  school  wishing 
to  attract  the  better  class  of  applicants,  will  give  preference  to  those  with 
higher  educational  credentials,  and  will  proceed  as  rapidly  as  possible  to  the 
full  high  school  requirement,  which  is  insisted  upon  for  every  other  type  of 
professional  training. 

Nursing  schools  should  secure  the  cooperation  of  high  school  principals  and 
teachers,  in  urging  girls  who  are  interested  in  nursing  to  complete  the  full  high 
school  course,  and  in  advising  them  regarding  the  best  selection  of  pre-nursing 
subjects.  Such  students  should  all  complete  the  regular  college  preparatory 
work  if  possible,  because  they  may  wish  to  enter  a  college  for  part  of  their  pro- 
fessional work  either  before  or  after  training,  and  because  the  regular  cultural 
courses  are  all  desirable  as  a  basis  for  nursing  work.  Wherever  there  is  free- 
dom for  election,  science  courses,  especially  chemistry,  physics  and  physiology, 
should  be  chosen,  and  household  science  should  be  included  if  at  all  possible. 
Mathematics  is  of  relatively  minor  importance  (apart  from  good  sound  arith- 
metic). It  is  a  disputed  question  whether  a  modern  language  is  not  of  more 
value  than  Latin,  but  one  year  at  least  of  Latin  is  decidedly  helpful  in  getting 
hold  of  technical  terms.  Music,  drawing,  physical  training  and  voice  culture 
are  all  helpful  and  should  be  included  if  possible. 

Deficiencies 

Applicants  who  are  deficient  in  general  education,  but  who  qualify  in  other 
ways,  should  be  advised  to  make  good  the  deficiency  by  returning  to  high 
school,  attending  night  school,  taking  extension  or  summer  courses  in  con- 
nection with  a  university  or  normal  school,  or  by  securing  a  special  tutor  to 
prepare  them  for  the  state  examinations.  Slight  deficiencies  might  be  made 
up  after  entering  the  nursing  school,  but  this  is  not  generally  advisable,  owing 
to  the  pressure  of  other  studies  and  the  demands  of  practical  work.  It  should 
be  distinctly  understood  that  credits  for  admission  to  nursing  schools  should 
be  made  up  in  approved  high  school  subjects  and  not  in  stenography,  book- 
keeping, and  other  technical  courses  which  would  be  of  much  less  value  as  a 
basis  for  nursing  work.  As  a  rule,  such  subjects  as  English,  history  or  civics, 
chemistry,  physics,  biology  and  arithmetic  (if  not  covered  elsewhere)  should 
receive  first  place,  but  languages,  physical  geography,  and  household  science 
would  also  be  of  definite  value  to  the  prospective  nursing  student. 

Advanced  Standing 

It  is  recommended  that  applicants  who  bring  educational  credentials  in 
advance  of  high  school  graduation,  should  be  allowed  advanced  standing  in 
nursing  schools  under  the  following  conditions : 


26  HOSPITAL   AND   TRAINING   SCHOOL   STANDARDS 

1.  Graduates  of  approved  colleges  giving  the  regular  four-years'  course  lead- 
ing to  the  A.B.  or  B.S.  degree,  should  be  allowed  credit  in  time  amounting  to 
one  academic  year  (eight  or  nine  months),  and  should  not  be  required  to  repeat 
class  work  which  had  been  satisfactorily  covered  elsewhere.* 

It  is  suggested  that  this  reduction  in  time  should  be  allowed  only  to  those 
who  have  graduated  comparatively  recently,  and  who  have  completed  satis- 
factorily in  college  about  one  year's  study  in  each  of  the  fundamental  sciences 
on  which  nursing  is  based — biology,  chemistry,  sociology  and  psychology.  The 
year  of  biology  might  include  such  subjects  as  physiology,  bacteriology,  bot- 
any, nutrition,  hygiene,  and  sanitation;  physics  might  be  accepted  for  part  of 
the  year  of  chemistry;  economics  or  social  economy-for  the  sociology  require- 
ment, and  courses  in  ethics  or  education  for  part  of  the  year  in  psychology. 
One  year's  work  in  a  given  subject  usually  means  from  two  to  six  hours  weekly 
throughout  the  year  in  that  subject,  depending  on  whether  it  is  a  lecture  or 
laboratory  course. 

2.  Students  from  schools  of  household  arts,  normal  schools,  and  others 
representing  work  in  advance  of  high  school,  who  have  completed  satisfactorily 
such  subjects  in  the  training  school  curriculum  as  anatomy  and  physiology, 
bacteriology,  chemistry,  nutrition  and  cookery,  etc.,  should  be  exempt  from 
compulsory  attendance  on  those  courses,  but  should  be  required  to  take 
examinations  with  other  students. 

3.  Credit  for  previous  work  in  approved  training  schools  should  be  granted, 
providing  the  student's  character  and  records  are  satisfactory,  the  reasons  for 
changing  are  good,  and  the  experience  in  the  first  school  is  comparatively 
recent.     A  minimum  of  about  two  years  should  be  spent  in  the  hospital  giving 
the  diploma.     Such  a  student  should  not  be  required  to  repeat  work  already 
satisfactorily  covered  in  theory  or  practice. 

Age 

The  minimum  age  at  which  students  should  be  accepted  in  schools  of  nursing 
is  twenty  years,  with  occasional  exceptions  in  favor  of  young  women  of  nine- 
teen years  of  tested  capability  and  unusual  maturity,  both  physical  and 
mental.  The  maximum  age  should  be  about  thirty-five  years,  with  rare  ex- 
ceptions in  favor  of  persons  of  unusual  physical  vigor  and  proven  adaptability. 

Health 

The  applicant  should  be  of  average  height  and  weight  and  free  from  organic 
defects.  She  should  present  a  recent  certificate  of  good  health  from  a  physi- 
cian, showing  not  only  that  her  constitution  is  sound  and  her  general  resistance 
good,  but  that  her  mental  and  nervous  make-up  is  normal  and  stable,  and  her 
whole  personality  of  a  good  wholesome  type.  This  is  a  protection  both  to  the 
school  and  the  student.  A  certificate  from  a  dentist  should  also  be  required. 

*  A  number  of  representative  training  schools  have  recently  (1917)  agreed 
to  admit  college  graduates  on  this  basis,  and  already  there  is  a  very  gratifying 
increase  in  the  numbers  of  college  women  coming  into  the  profession.  Sug- 
gestions for  working  out  a  scheme  of  training  under  these  conditions  will  be 
found  in  Appendix  V. 


HOSPITAL  AND  TRAINING   SCHOOL  STANDARDS  27 

Before  acceptance  into  the  school,  the  student  should  have  a  thorough  physical 
examination  by  the  training  school  physician,  and  it  is  very  desirable  that  a 
similar  examination  should  be  made  at  the  'end  of  the  training,  to  determine 
just  what  the  general  physical  effects  of  the  training  have  been. 

Character  and  Experience 

Certificates  of  character  are  usually  of  uncertain  value,  but  should  be  re- 
quired in  view  of  the  nature  and  responsibilities  of  the  nurse's  work.  A  per- 
sonal interview  with  the  applicant  is  always  desirable.  Direct  correspondence 
between  the  school  and  the  persons  given  as  reference  is  advised.  Wherever 
there  seems  to  be  any  doubt  as  to  character,  a  careful  investigation  should  be 
made.  Experience  in  home  management,  in  business  and  in  social,  educational 
or  club  work,  are  distinct  assets.  The  applicant  who  belongs  to  a  cultured 
family  with  traditions  of  public  service,  who  has  travelled  and  seen  something 
of  life  and  people,  is  (other  things  being  equal)  generally  found  to  be  better 
fitted  for  success  in  nursing  work. 

I.  THE  ADMISSION  OF  CLASSES 

Among  the  many  points  in  the  organization  of  training  school  work  which 
need  careful  consideration,  is  the  question  of  the  number  of  classes  admitted 
yearly.  In  some  schools  new  classes  are  formed  twice  yearly;  in  others  three 
or  even  four  times  yearly;  in  still  others  students  are  admitted  irregularly, 
whenever  vacancies  must  be  filled.  It  is  hardly  necessary  to  point  out  that 
this  method  makes  the  conduct  of  a  good  curriculum  exceedingly  difficult. 
Certain  subjects  must  be  repeated  three  or  four  times  during  the  year,  and 
students  must  of  necessity  enter  some  of  the  classes  in  which  repetition  is 
impossible  at  late  dates,  and  endeavor  to  pick  up  what  they  can.  The  burden 
laid  upon  the  teaching  staff  of  constant  repetition  is  a  heavy  one,  which  the 
always  insufficient  force  of  instructors  complicates.  So  long  as  the  system  of 
student  nursing  service  exists,  it  will  undoubtedly  be  necessary  to  admit 
students  twice  yearly,  in  order  that  the  hospital  service  may  not  suffer  from 
the  removal  at  any  one  time  of  a  considerable  number  of  skilled  workers,  but 
in  the  interests  of  both  students  and  teachers,  the  time  of  admitting  classes 
should  be  kept  as  nearly  as  possible  to  twice  yearly.  The  commonly  accepted 
time  in  most  training  schools  now  conforms  to  those  in  other  kinds  of  schools 
— in  September  or  October  for  the  autumn  and  in  January  or  February  for  the 
spring.  In  establishing  relationships  with  colleges  or  other  similar  institu- 
tions, these  periods  will  be  found  convenient  as  fitting  in  closely  with  their 
schemes  of  teaching. 

J.  STANDARDS  AND  METHODS  OF  GOOD  TEACHING 

In  teaching  nurses  we  have  always  to  keep  clearly  in  view  the  objects  of  the 
training.  If  the  pupil  is  to  be  able  to  undertake  the  duties  and  responsibilities 
which  meet  her  in  the  hospital  and  in  the  various  fields  of  nursing  outside,  she 
must  have  not  only  a  certain  amount  of  sound  knowledge,  a  high  degree  of 


28  HOSPITAL   AND   TRAINING   SCHOOL   STANDARDS 

technical  skill  and  the  spirit  of  service,  but  she  must  have  a  well-trained  mind, 
good  powers  of  observation,  the  ability  to  handle  people  and  to  manage  affairs, 
and  high  ethical  standards. 

The  test  of  the  teaching  done  in  any  school  will  be  found  not  only  in  the 
examination  records,  but  in  the  actual  accomplishment  of  these  results  by  the 
pupil.  It  should  be  judged  not  only  by  the  present  standing,  but  by  the 
future  growth  and  progress  of  the  members  of  that  school.  The  quality  of 
teaching  can  be  measured  by  a  few  fundamental  tests : 

First.  Where  good  teaching  is  being  done  the  pupils  are  interested  in  their 
work — they  do  not  need  to  be  driven  to  it  by  threats  or  bribes.  The  work  is 
vital  to  them  because  it  meets  their  needs,  it  helps  them  to  solve  their  problems 
and  it  arouses  in  them  worthy  and  serious  hopes  and  ambitions  which  persist 
in  their  future  life. 

Second.  The  pupils  are  doing  real  live  thinking  for  themselves,  and  not 
simply  memorizing  facts.  They  are  observing,  comparing,  judging,  and  learn- 
ing to  seek  out  reasons  and  weigh  conclusions.  They  show  good  sense  and 
rational  judgment  in  their  handling  of  every-day  situations,  as  well  as  in  their 
class  work.  They  relate  their  theory  to  their  practice. 

Third.  The  pupils  show  the  clearness  and  thoroughness  of  their  knowledge 
by  their  ability  to  systematize  and  classify  their  ideas  and  to  find  them  when 
needed.  They  do  not  simply  accumulate  masses  of  scrappy,  unrelated  facts. 
Their  answers  to  questions,  their  class  notes,  and  their  method  of  setting  about 
a  practical  task,  will  all  show  their  ability  to  grasp  the  essential  points,  to  sub- 
ordinate the  unessential  and  to  focus  all  their  resources  on  the  problem  in 
hand. 

Fourth.  Good  teaching  is  shown  by  the  degree  of  self-reliance,  initiative  and 
resourcefulness  developed  in  the  pupils,  and  their  ability  to  adapt  and  apply 
their  knowledge  in  new  situations.  The  pupil  who  is  absolutely  dependent  on 
the  teacher,  who  cannot  take  any  step  without  guidance  and  help,  will  not  be 
of  much  use  in  the  hospital  or  in  the  future  work  of  her  profession.  The  kind 
of  teaching  which  substitutes  tradition  and  authority  for  inquiry  and  investi- 
gation, which  discourages  mental  activity  and  free  self-expression  and  which 
destroys  originality  and  initiative,  is  no  longer  accepted  as  good  in  any  branch 
of  education. 

The  first  thing  for  a  teacher  to  decide  is  just  what  she  wants  to  accomplish 
through  any  given  subject,  and  she  must  then  plan  all  her  work  with  this  in 
mind.  She  must  also  study  her  pupils  to  see  what  kind  of  material  she  has  to 
work  with,  and  what  foundations  she  has  to  build  on,  so  that  the  work  may  be 
neither  above  nor  below  their  capacity.  She  must  select  her  subject-matter 
with  these  two  things  in  mind,  and  must  then  arrange  an  outline  of  work  in 
each  subject,  divided  into  well-defined  topics,  which  will  receive  attention  in 
proportion  to  their  relative  importance.  Different  subjects  in  the  curriculum 
should  be  correlated  in  every  possible  way. 

Every  detail  of  teaching  should  be  planned  out  ahead,  and  not  left  to  the 
spur  of  the  moment.  Slavish  dependence  on  a  text-book  usually  means  slip- 
shod, ineffective  teaching,  and  rambling  remarks,  no  matter  how  interesting, 
can  never  take  the  place  of  clear-cut,  well-directed  questioning  and  thoughtful 
discussion. 


HOSPITAL  AND  TRAINING  SCHOOL  STANDARDS  29 

A  lesson-plan  should  be  made  out  for  each  class,  taking  up  in  the  form  of  a 
well-organized  outline,  all  the  main  points  to  be  discussed.  The  teacher 
should  also  have  thought  out  beforehand  her  procedure  in  the  teaching  of  the 
lesson — the  important  questions  she  is  to  ask,  the  blackboard  illustrations  she 
is  to  use,  the  devices  and  material  for  demonstration  and  the  plan  for  the  pupils' 
practical  work,  reference  readings,  study,  etc. 

The  work  of  the  class-room  should  be  organized  so  as  to  secure  the  maximum 
of  cooperation  and  efficiency,  and  the  least  loss  of  time  and  energy.  This  is 
especially  important  in  the  arrangement  of  classes  in  practical  work,  where, 
owing  to  lack  of  equipment  and  limited  space,  there  is  often  serious  waste  of 
time  for  both  pupils  and  teacher.  It  is  scarcely  necessary  to  state  that  classes 
should  begin  on  time  and  finish  on  time,  and  that  regular  and  prompt  attend- 
ance on  classes  should  be  insisted  upon. 

The  type  of  class  exercise  or  recitation  should  be  adapted  to  the  subject 
taught,  to  the  time  available,  and  to  the  resources  of  the  school.  Those  which 
are  best  adapted  to  the  work  in  training  schools  and  which  are  suggested  in 
this  curriculum,  are  as  follows: 

The  Lecture  Method 

This  takes  the  form  of  a  talk  or  address  by  the  teacher,  with  no  questions  or 
responses  by  the  pupil.  It  can  be  used  profitably  for  introducing  new  material 
or  arousing  interest  in  a  subject.  It  is  economical  of  time,  but  it  is  limited  in 
its  teaching  value  unless  supplemented  by  other  methods. 

The  Recitation  Method 

This  covers  a  variety  of  class  exercises — the  drill,  the  quiz,  the  oral  or  writ- 
ten review,  as  well  as  the  testing  of  assigned  recitations.  The  problem  method 
is  a  newer  form  of  class  exercise  which  is  devoted  to  the  discussion  and  solving 
of  certain  typical  problems  or  situations  which  the  pupil  is  likely  to  meet  in 
actual  life.  Such  methods  help  to  maintain  higher  interest,  help  to  clear  up 
difficulties  and  test  the  actual  knowledge  of  the  pupil,  as  well  as  develop  the 
power  of  oral  and  written  expression  and  judgment. 

One  or  more  of  these  methods  would  be  used  alone  or  in  combination  with 
other  methods  in  practically  every  lesson.  Their  success  depends  on  the  skill 
of  the  teacher  in  putting  live  questions  and  directing  discussion  along  profit- 
able lines. 

The  Demonstration  or  Clinic 

This  is  a  lesson  conducted  at  the  bed-side  or  in  the  demonstration  room,  for 
the  purpose  of  showing  certain  conditions  or  performing  certain  experiments 
or  practical  procedures  for  the  class.  It  is  especially  useful  in  the  presentation 
of  medical  subjects  and,  in  combination  with  the  two  previous  methods,  is 
used  in  nearly  all  the  scientific  and  practical  subjects.  The  excursion  method 
is  a  modification  of  the  demonstration,  where  pupils  visit  places  illustrating 
certain  conditions  which  they  wish  to  study. 

The  Laboratory  Method 

Pupils  here  actually  carry  out  experiments  and  practical  procedures,  in 
order  to  get  a  more  complete  understanding  of  the  principles  involved  and  to 


30  HOSPITAL  AND  TRAINING  SCHOOL  STANDARDS 

gain  skill.  This  method  is  used  in  combination  with  those  previously  men- 
tioned in  all  the  scientific  subjects  (anatomy  and  physiology,  chemistry,  bac- 
teriology, etc.)  and  in  all  the  practical  subjects  (nursing,  cookery,  massage, 
etc.).  It  takes  time,  but  is  an  extremely  valuable  and  effective  method  of 
teaching,  if  properly  handled.  No  up-to-date  school  or  college  attempts  to 
teach  any  science  or  art,  without  providing  laboratory  facilities  for  each 
pupil. 

The  Conference  or  Case-Study  Method 

This  is  used  with  more  advanced  pupils,  who  are  capable  of  gathering  to- 
gether their  own  material  and  presenting  reports  on  their  observations  or 
practical  work,  which  are  then  discussed  and  criticized  by  the  class  and 
teacher.  Such  a  method  can  be  most  profitably  used  in  such  subjects  as 
Professional  Problems,  Introduction  to  Public  Health  Nursing,  etc. 

The  Study  Period 

With  more  immature  pupils  it  is  often  found  helpful  to  arrange  definite 
periods  of  supervised  study,  with  instruction  in  the  method  of  study  and  dem- 
onstrations in  the  use  of  reference  materials,  taking  of  notes,  etc.  This  is 
particularly  necessary  in  the  preparatory  period,  where  pupils  have  difficulty 
in  acquiring  the  habit  of  study  and  where  it  is  important  to  economize  every 
available  minute  of  study  time. 

The  teacher  who  has  had  no  special  training  in  teaching  will  find  it  very  help- 
ful to  study  some  of  the  books  on  teaching  which  are  included  in  the  bibliog- 
raphy at  the  end  of  this  article.  It  is  suggested  that  groups  of  head  nurses 
and  supervisors  might  be  organized  for  the  study  of  some  of  these  commoner 
teaching  problems,  and  if  regular  lecturers  cannot  be  secured  from  a  university 
or  normal  school,  they  might  form  into  a  club  for  the  discussion  of  teaching 
and  administrative  problems. 

K.  TEACHING  EQUIPMENT 

To  accomplish  satisfactory  results,  a  school  should  provide  for  its  teaching 
work  comfortable,  well-lighted,  well-ventilated  class-rooms  and  laboratories, 
such  as  are  found  in  all  modern  educational  institutions.  The  number  and 
size  of  the  class-rooms  will  depend  on  the  size  of  the  school,  but  most  schools 
will  need  at  least  a  general  class  and  lecture  room,  a  demonstration  room,  and 
a  diet  kitchen  equipped  for  teaching.  A  science  laboratory  for  the  teaching 
of  chemistry,  anatomy  and  physiology,  bacteriology,  solutions,  etc.,  is  also 
desirable,  but  in  a  small  school  the  regular  class-room,  or  demonstration  room, 
or  the  pathological  laboratory  may  be  equipped  to  serve  for  this  purpose. 
Where  the  hospital  does  not  afford  a  well-equipped  dietetic  laboratory,  it  is 
often  possible  to  secure  the  use  of  a  high  school  or  technical  school  laboratory. 
Medical  schools  may  also  furnish  excellent  facilities  especially  for  the  teaching 
of  the  sciences.  All  class-rooms  should  be  supplied  with  ample  blackbard 
spaces  and  cither  chairs  and  tables,  or  chairs  with  the  desk  arm. 

Under  each  course  will  be  found  a  suggestive  list  of  equipment  and  illus- 
trative material  to  be  used  in  teaching  the  various  subjects.  While  ample 
equipment  is  not  enough  in  itself  to  guarantee  good  teaching,  it  is  practically 


HOSPITAL  AND  TRAINING   SCHOOL  STANDARDS  31 

impossible  to  teach  nursing  subjects  without  a  fairly  complete  and  up-to-date 
equipment  and  abundance  of  illustrative  material.  Much  of  this  is  easily 
secured  in  a  hospital  (beds,  linen,  utensils,  chemicals,  laboratory  supplies, 
etc.),  and  a  great  deal  can  be  readily  improvised  by  an  ingenious  teacher. 
The  bulk  of  the  material  for  class-room  use  should  be  kept  for  this  purpose 
only  and  should  be  properly  arranged  and  cared  for,  so  that  it  will  not  be 
scattered  and  destroyed. 

A  good  reference  library  is  absolutely  essential  to  satisfactory  teaching 
work.  The  size  of  the  library  is  not  the  main  thing,  though  it  is  important 
that  it  should  represent  a  fairly  wide  range  of  subjects.  The  books  must  be 
up-to-date  and  reliable,  and  in  good  condition.  If  possible,  a  special  room 
should  be  set  apart  for  the  reference  library  where  students  can  read  and  study 
without  interruption,  and  a  responsible  person  should  be  put  in  charge.  It  is 
very  important  that  students  should  have  easy  access  to  the  reference  books 
and  that  they  should  be  encouraged  to  make  the  fullest  possible  use  of  them. 
The  text  and  reference  books  and  magazines  recommended  under  the  different 
subjects  of  the  curriculum  would  make  a  fairly  complete  working  library  for 
the  average  training  school.  If  it  is  impossible  to  secure  all  of  these  books, 
the  public  library  is  usually  willing  to  put  upon  its  shelves  books  of  a  more 
general  nature  which  will  be  used  by  pupil  nurses,  and  in  many  cases  will 
install  a  "travelling"  unit,  or  a  branch  library  in  the  school. 

L.  RECORDS 

It  is  essential  that  a  good  system  of  records  should  be  established  which  will 
provide  full  and  exact  statements. of  the  work  which  every  student  has  done, 
and  which  will  also  give  certain  details  regarding  the  health,  general  education, 
personality  and  character  of  each  student  who  has  been  in  the  school.  The 
importance  of  this  matter  can  hardly  be  overestimated.  Records  are  needed 
constantly  for  reference  by  the  superintendent  and  staff  of  the  training  school, 
and  serve  as  a  useful  check  of  the  actual  training  which  each  pupil  is  getting. 
A  new  superintendent  entering  a  training  school  has  no  other  means  of  deter- 
mining the  standing  of  the  pupils  and  the  experience  they  have  had.  The 
graduate  nurse  who  wishes  to  enter  the  Red  Cross,  or  take  any  of  the  post- 
graduate courses  which  are  now  offered  in  colleges,  will  have  to  furnish  com- 
plete records  of  her  work  in  the  training  school.  The  only  way  in  which  these 
records  can  be  supplied  is  through  her  school,  and  if  they  are  not  available,  the 
standing  of  both  the  nurse  and  the  hospital  is  likely  to  be  seriously  questioned. 

The  records  of  theoretical  instruction  should  cover  the  subjects,  the  number 
of  periods  of  class,  lecture  or  laboratory  in  each,  the  years  in  which  each  sub- 
ject was  studied  and  the  grades  which  the  student  has  made.  Class  books, 
with  a  record  of  attendance  for  each  class,  should  be  kept  by  each  teacher,  and 
the  results  filed  on  the  student's  card  when  the  class  has  been  completed. 

The  record  of  practical  training  in  each  department  should  include  the  dates 
of  such  periods  and  the  number  of  days  or  weeks  in  each.  As  before  stated, 
the  time  spent  in  a  given  department  may  not  accurately  indicate  the  actual 
training  and  experience  of  the  student,  but  at  present  this  seems  about  the 
only  method  of  measurement  available,  except  in  maternity  work,  where  the 
number  of  cases  often  determines  the  period  of  training.  It  is  suggested  that 


32  HOSPITAL   AND   TRAINING    SCHOOL   STANDARDS 

every  effort  be  made  to  keep  track  of  the  number  and  variety  of  cases  which 
the  student  has  observed  and  cared  for,  in  all  services,  and  that  a  blank  be 
supplied  to  each  student  for  this  purpose.  A  number  of  suggestive  blanks 
will  be  found  in  the  Modern  Hospital  of  July,  1917,  covering  not  only  the 
records  of  pupils  in  the  school,  but  also  admission  blanks,  health  certificates, 
etc. 

It  cannot  be  too  strongly  emphasized  that  a  few  simple  blanks,  kept  with 
absolute  accuracy,  are  of  greater  value  than  a  very  elaborate  system  which  is 
poorly  kept.  It  is  obvious  that  properly  trained  secretarial  help  is  required 
for  the  handling  of  such  records,  and  correspondence  relating  to  the  school, 
and  that  the  valuable  services  of  expert  nurses  should  not  be  employed  in  this 
way  under  ordinary  circumstances. 

M.  UNIVERSITY    AFFILIATIONS 

The  advantages  of  university  or  college  relationship  for  schools  of  nursing 
are  likely  to  be  very  great.  Precisely  those  essentials  in  all  educational  work 
which  the  hospital  finds  it  most  difficult  to  supply,  are  freely  available  in  every 
college  or  university  of  good  standing — properly  equipped  class-rooms  and 
laboratories,  libraries  and  other  teaching  material;  adequately  trained  teach- 
ers ;  associations  with  teachers  and  students  interested  in  other  lines  of  thought 
and  activity;  the  atmosphere  of  study — all  of  these,  and  other  things  less 
tangible  are  to  be  expected  from  any  good  university  connection.  The  results 
in  improving  the  standards  of  theoretical  work  in  schools  of  nursing  in  helping 
to  maintain  the  right  balance  between  theory  and  practice  and  particularly 
in  attracting  better  qualified  candidates,  can  hardly  be  overestimated. 

The  value  of  this  relationship  appears  to  be  in  proportion  to  the  degree  in 
which  the  university  participates  in  the  direction  of  the  entire  scheme  of  train- 
ing school  work.  Several  such  schools  now  established  as  regular  departments 
of  universities,  give  evidence  not  only  of  excellent  standards  and  ideals  of 
work,  but  of  ability  to  grow  and  develop,  to  try  out  new  ideas  and  methods. 

Where,  however,  the  university  opens  up  its  class-rooms  and  laboratories 
to  classes  of  students  from  schools  of  nursing  and  fails  to  look  into  the  nature 
of  the  practical  training  in  the  hospital  and  the  conditions  under  which  it  is 
carried  on,  the  result  may  be  far  from  satisfactory. 

The  university  must  exact  thorough  work  from  its  students,  and  it  must 
require  a  good  many  hours  of  study.  If  this  is  combined  with  the  usual  hours 
of  duty,  there  is  imposed  upon  the  student  a  program  of  study  and  work  which 
it  is  entirely  impossible  for  her  to  carry  out.  All  university  relationships  pre- 
suppose a  rational  system  of  hours  of  duty,  and  there  can  be  no  escape  from  the 
ruling  that  every  increase  in  the  amount  of  theory  means  a  corresponding 
decrease  in  the  amount  of  practical  work. 

N.  REFERENCES   ON   NURSING   EDUCATION    AND    TEACHING 

ROBB,  ISABEL  HAMPTON.     Educational  Standards  for  Nurses. 

BEARD,  RICHARD  OLDING.  The  University  Education  of  the  Nurse.  Fif- 
teenth Annual  Report  of  Society  of  Superintendents  of  Training 
Schools  (1909),  also  Teachers  College  Record,  May,  1910. 


HOSPITAL  AND  TRAINING  SCHOOL  STANDARDS  33 

The  Trained  Nurse  of  the  Future.     Journal  of  the  American  Medical 

Association,  December  13,  1913. 
WASHBURN,  F.  A.  (M.D.)    Supply  of  Pupil  Nurses  and  Nursing  Standards. 

Fourteenth  Annual  Report,  American  Hospital  Association,  1912. 
ROWLAND,  J.  B.     Obligations  of  the  Hospital  and  the  Public  to  Training 

Schools  for  Nurses.     Journal  of  the  American  Medical  Association, 
.     December  13,  1913. 
SMITH,  WINFORD  N.   (M.D.)     The  Educational  Function  of  the  Hospital. 

Twenty-first  Annual   Report  of  the   National   League   of  Nursing 

Education  (1915). 
HALL,  HENRY  C.     The  Trusteeship  of  Training  Schools.    American  Journal 

of  Nursing,  May,  1915. 
HURD,  HENRY  M.  (M.D.)     Shall  Training  Schools  be  Endowed?    American 

Journal  of  Nursing,  September,  1906. 
FAVILL,  HENRY  B.  (M.D.)    What  the  Medical  Profession  Can  Contribute  to 

Nursing  Education.    American  Journal  of  Nursing,  January,  1916, 

and  Twenty-first  Annual  Report  of  National  League  of  Nursing 

Education  (1915). 
MURPHY,  FRED  T.  (M.D.)    Demand  and  Supply  as  Related  to  Nurses  and 

Nursing.    Modern  Hospital,  October,  1914,  and  Twentieth  Annual 

Report  of  National  League  of  Nursing  Education  (1914). 
DOCK,   GEORGE   (M.D.)     Essentials  of  Professional  Education.     Twentieth 

Annual  Report  of  National  League  of  Nursing  Education  (1914). 
WINSLOW,  C.-E.  A.    The  Public  Health  Nurse  and  Her  Preparation  for  Her 

Calling.     Pamphlet,  published  by  National  Organization  for  Public 

Health  Nursing. 
NUTTING,  ADELAIDE.     Educational  Status  of  Nursing  (Pamphlet,  Publication 

Bureau,  Washington). 
A  Sounder  Economic  Basis  for  Training  Schools  for  Nurses.     Teachers 

College  Record,  January,  1916. 
Hospital   Trustees  and   the   Training  School.     Twentieth  Report   of 

National  League  of  Nursing  Education  (1914). 

Some  Problems  of  the  Training  School  for  Nurses.     Transaction  Ameri- 
can Hospital  Association,  1908,  and  Canadian  Nurse,  December,  1908. 
Some  Ideals  in  Training  School  Work.     Twenty-second  Annual  Report 

of  National  League  of  Nursing  Education  (1916). 
GOODRICH,  ANNIE  W.     How  Shall  the  Superintendents  of  Small  Hospitals  Be 

Trained?    The  Modern  Hospital,  November,  1916. 
STEWART,  ISABEL  M.     Problems  of  Nursing  Education.     Teachers  College 

Record,  May,  1910. 
Apprenticeship  as  a  Method  of  Vocational  Education   (with  Special 

Application  to  Nursing).     Seventeenth  Annual  Report  of  Society  of 

Superintendents  of  Training  Schools  (1911). 

BELL,  ALICE.     Training  School  Records.     Modern  Hospital,  July,  1917. 
TUCKER,  KATHARINE.     The  Training  School's  Responsibility  in  Public  Health 

Nursing  Education.     Twenty-second    Annual   Report    of   National 

League  of  Nursing  Education  (1916). 


34  HOSPITAL  AND  TRAINING   SCHOOL  STANDARDS 

FOLEY,  EDNA  L.     Fundamental  Requirements  in  the  Training  of  the  Public 

Health   Nurse.     Twentieth  Annual   Report   of  National  League  of 

Nursing  Education  (1914). 
LEE,  FREDERICK,  S.  (M.D.)    Fatigue. 
GOLDMARK,  JOSEPHINE.     Fatigue  and  Efficiency. 
BULLETIN  221.     United  States  Bureau  of  Labor-Statistics.     Hours,  Fatigue 

and  Health  in  British  Munitions  Factories. 
JAMME,  ANNA.     Effect  of  Legislation  upon  Schools  of  Nursing  in  California. 

Modern  Hospital,  August,  1915. 

SNEDDEN,  DAVID.     Problems  of  Vocational  Education. 
DEWET,  JOHN.     How  We  Think. 
McMtiRRY,  FRANK  M.     How  to  Study. 

STRAYER,  GEORGE  D.  AND  NORSWORTHY,  NAOMI.    How  to  Teach. 
PARKER,  SAMUEL  C.     Methods  of  Teaching  in  High  Schools. 
BETTS,  GEORGE  H.     The  Recitation. 
WHIPPLE,  GUY  M.    How  to  Study  Effectually. 
JAMES,  WILLIAM.     Talks  to  Teachers. 

Psychology  (Briefer  Course). 
THORNDIKE,  EDWARD.     Elements  of  Psychology  and  Principles  of  Teaching. 

Individuality. 

COLVIN,  STEPHEN  S.  AND  BAGLEY,  WILLIAM  C.     Human  Behavior. 
PALMER,    GEORGE    H.    AND    FREEMAN,    ALICE.     The    Teacher.     Houghton- 

Mifflin. 
See  also  articles  in  American  Journal  of  Nursing  and  other  Nursing  Periodicals. 


THE  COURSE  OF  STUDY 

A.  LENGTH  OF  COURSE  AND  GENERAL    DIVISION  OF    TIME 

The  length  of  the  course  is  three  calendar  years,  divided  into  the  preparatory 
or  first  year,  the  junior  or  second  year,  and  the  senior  or  third  year. 

One  month  should  be  allowed  each  year  for  vacations.     These  should  all  be 

arranged  for  the  summer  term,  when  no  lectures  and  classes  are  being  given. 

The  academic  or  class  year  would  be  the  same  as  in  most  other  educational 

institutions,  extending  from  the  first  week  of  October  till  the  end  of  May, 

(about  thirty- two  weeks). 

This  period  is  generally  divided  into  two  terms  of  about  sixteen  weeks  each 
— the  first,  or  winter  term,  extending  from  October  to  January  (allowing  at 
least  one  week  for  Christmas  vacation) ;  the  second,  or  spring  term,  extending 
from  February  till  May.  New  classes  would  be  admitted  in  the  beginning  of 
the  winter  and  spring  terms  only. 

It  would  usually  be  assumed  that  the  last  week  of  each  term  would  be  de- 
voted to  examinations,  leaving  about  fifteen  weeks  each  term  for  class  and 
lecture  work. 

The  general  schedule  of  hours  suggested  for  the  first  four  months  or  prelimi- 
nary term  is  as  follows : 

4  hours  daily  in  practical  work. 
3  hours  daily  in  lecture  and  class. 
3  hours  daily  in  study  and  practice. 
2  hours  daily  in  recreation. 

For  the  subsequent  terms  the  schedule  would  be  as  follows : 
8  hours  daily  in  practical  work, 
f  to  1  hour  (average)  daily  in  lecture  and  class  work. 

1  hour  daily  for  study. 

2  hours  daily  for  recreation. 

This  means  10  hours  of  actual  required  work  daily  throughout  the  academic 
year — with  the  exception  of  Sundays,  when  class  work  and  study  would  be 
omitted,  and  the  one  day  a  week  when  an  afternoon  off  is  allowed.  So  far  as 
possible  evening  hours  should  be  left  free  from  all  class  and  lecture  work. 

The  hours  for  night  duty  should  be  the  same  as  for  day  duty — in  any  case 
never  to  exceed  ten  hours  a  night.  The  total  length  of  night  duty  should  not 
exceed  four  months  and  not  more  than  two  months'  night  duty  should  be  given 
at  any  one  time.  The  first  term  of  night  duty  should  be  as  an  assistant,  not  in 
charge  of  a  floor. 

B.  GENERAL  SCHEME  OF  PRACTICAL  INSTRUCTION 

Division  of  Time  for  Practical  Work 

Preliminary  or  Probationary  Period 4  months. 

If  possible,  the  pupil  is  not  to  be  counted  upon  for  any  regular  ward 
duties  during  this  time,  and  her  practical  work  should  not  exceed  4 
hours  daily.  Her  practice  in  the  various  departments  is  for  the  pur- 

35 


36  THE   COURSE   OF  STUDY 

pose  of  giving  her  a  background  for  her  class  work,  and  helping 
her  to  apply  the  methods  which  she  has  learned  in  the  class-room. 
It  is  also  an  opportunity  for  testing  out  her  ability  for  nursing  work. 
The  practice  should  be  closely  tied  up  with  her  studies,  and  should 
be  under  the  careful  supervision  of  the  instructor.  Each  pupil 
should,  if  possible,  have  a  short  period  of  time  in  each  of  the  fol- 
lowing departments: — diet  kitchen,  hospital  supply-room,  linen- 
room,  dispensary,  and  wards.  Time  should  also  be  provided  for  a 
few  visits  to  homes  with  social  service  workers  or  visiting  nurses,  in 
order  that  the  pupil  may  see  for  herself  the  conditions  under  which 
many  of  her  patients  live. 

Medical  Nursing 8  months. 

This  time  is  to  be  divided  among  medical  wards  (men's  and 
women's).  The  medical  service  should  provide  experience  in  the 
care  of  all  the  commoner  medical  diseases,  the  greater  proportion  of 
which  should  be  acute.  In  addition  to  typhoid  fever,  pneumonia 
and  such  communicable  diseases  as  may  be  cared  for  in  general  medi- 
cal wards,  it  is  important  that  experience  should  be  given  in  the  care 
of  tuberculosis  and  also,  if  at  all  possible,  the  acute  infectious  dis- 
eases, such  as  scarlet  fever,  diphtheria,  measles,  etc.  If  the  hospital 
docs  not  care  for  mental  and  nervous  cases,  it  is  urged  that  affilia- 
tions with  mental  hospitals  should  be  secured  to  give  this  training. 

Surgical  Nursing 8  months. 

This  should  be  divided  among  surgical  wards  (men's  and  women's) 
and  should  include  gynecological,  orthopedic  and  operating-room 
services.  The  surgical  experience  should  represent  a  fairly  wide 
range  of  operative  cases,  including  emergency  work.  Opportunity 
for  assisting  at  operations  and  doing  surgical  dressings  should  also 
be  provided. 

Nursing  in  Diseases  of  Infants  and  Children 4  months. 

This  time  should  be  given  in  special  wards  or  in  an  affiliated  hospital 
devoted  to  the  care  of  infants  and  children.  It  should  include  both 
boys  and  girls  and  should  cover  both  medical  and  surgical  conditions 
of  childhood.  If  possible,  some  experience  should  also  be  given  in 
the  handling  of  fairly  normal  run-about  children,  such  as  may  be 
be  found  in  the  children's  clinic.  Visiting  or  follow-up  work  in 
connection  with  the  children's  services  is  also  important.  Work 
in  the  milk-room,  in  preparation  of  infant's  feedings  should  be 
included  in  this  period. 

Obstetrical  Nursing 3  months. 

This  should  be  given  in  special  maternity  wards  or  in  an  affiliated 
hospital  devoted  to  obstetrical  work.  It  should  include  the  care  of 
both  normal  and  operative  cases,  and  of  normal  and  premature 
babies.  Out-patients'  service,  if  provided,  should  be  supplemen- 
tary to  the  above,  and  given  only  under  expert  supervision. 

Nursing  in  Special  Diseases 2  months. 

It  is  desirable,  though  not  always  possible,  to  give  practical  experi- 
ence in  eye,  ear,  nose  and  throat  work,  occupational,  venereal  and 


THE   COURSE   OF  STUDY  37 

skin  diseases,  etc.  This  may  be  secured  either  in  the  dispensary 
or  wards — preferably  in  both.  It  is  particularly  important  for 
those  who  are  planning  for  public  health  work. 

Electives 4  months. 

This  period  should  be  arranged,  so  far  as  possible,  with  reference 
to  the  special  aptitudes  and  future  plans  of  the  pupil.  Those  in- 
tending to  do  private  nursing  might  spend  part  of  the  time  in  the 
private  wards  or  in  special  duty.  Those  intending  to  enter  some 
form  of  public  health  nursing  should  be  detailed  to  the  hospital 
social  service  department,  or  to  an  affiliated  visiting  nurse  associa- 
tion (only,  however,  when  the  practical  work  there  can  be  as  thor- 
oughly supervised  as  the  work  in  the  hospital).  Those  who  expect 
to  go  into  some  form  of  institutional  work  may  assist  a  head-nurse 
or  supervisor  in  charge  of  some  hospital  department.  For  the 
remainder  of  this  period,  the  pupil  may  be  assigned  to  one  of  the 
regular  services  in  which  she  wishes  to  secure  further  experience 
and  training,  or  to  some  special  branch  of  work,  such  as  contagious, 
mental  hospital,  or  laboratory  work,  which  may  not  be  included  in 
the  regular  training. 

Vacations  (one  month  each  year) 3  months. 

Total 36  months. 

Arrangement  of  Practical  Training 

No  fixed  order  of  services  can  be  recommended,  as  this  must  depend  on  a 
great  many  factors  which  vary  widely  in  different  hospitals.  In  general,  how- 
ever, it  is  believed  to  be  important  that  experience  in  medical  and  surgical 
nursing,  should  precede  training  in  special  branches  and  that  services  demand- 
ing the  more  fundamental  and  uncomplicated  measures,  should  precede  those 
which  demand  considerable  differentiation  and  a  higher  degree  of  skill  and 
adaptability,  such  as  mental  nursing  or  children's  nursing.  Operating-room 
work  should  precede  obstetrics  and  all  the  regular  branches  of  hospital  service 
(such  as  children,  obstetrics,  contagious,  etc.)  should  be  covered  before  the 
pupil  takes  up  public  health  nursing  or  social  service.  The  following  arrange- 
ment is  suggested : 

Preparatory  or  First  Year: 

Elementary  nursing,  diet  kitchen  (elementary)  and  hospital 
housekeeping  (in  preliminary  course).  General  medical  and  general 
surgical  services. 

Junior  or  Second  Year: 

Infectious,  tuberculosis  and  admitting  services  (if  given);  chil- 
dren's service  and  milk-room;  gynecological,  orthopedic,  operating- 
room  and  obstetrical  services  (the  latter  will  frequently  be  extended 
into  the  third  year). 

Senior  or  Third  Year: 

Psychopathic  service  (including  practical  work  in  hydrotherapy 
and  occupation  therapy,  where  possible),  dispensary,  special  dis- 
eases. Advanced  or  special  work  in  any  one  of  the  regular  depart- 


38  THE   COURSE   OF  STUDY 

ments.  One  of  the  following  electives — (1)  special  duty  or  private 
ward  service,  (2)  hospital  social  service  or  visiting  nursing  service, 
(3)  executive  work  as  assistant  to  head-nurse  or  supervisor. 

C.  GENERAL  SCHEME  OF  THEORETICAL  INSTRUCTION 

*  Preparatory  or  First  Year 

First  or  Winter  Term  hours 

Anatomy  and  Physiology 60 

Bacteriology 20 

Personal  Hygiene 10 

Applied  Chemistry 20 

Nutrition  and  Cookery. r 40 

Hospital  Housekeeping 10 

Drugs  and  Solutions 20 

Elementary  Nursing  Principles  and  Methods 60 

Bandaging 10 

History  of  Nursing  (including  Social  and  Ethical  Principles). . .  15 

Total , 265 

Second  or  Spring  Term 

Elements  of  Pathology 10 

Nursing  in  Medical  Diseases 20 

Nursing  in  Surgical  Diseases 20 

Materia  Medica  and  Therapeutics 20 

Diet  in  Disease 10 

Elements  of  Psychology  (recommended) 10 

Total 80  to  90 

Junior  or  Second  Year 

First  or  Winter  Term 

Nursing  in  Communicable  Diseases 20 

Nursing  in  Diseases  of  Infants  and  Children  (including  Infant 

Feeding) 20 

^Massage 10 

Principles  of  Ethics 10 

Total...  .  60 


*  When  two  or  more  groups  are  brought  in  during  the  first  year,  it  will  be 
necessary  to  repeat  most  of  the  subjects  in  the  first  year  with  each  group,  so 
that  all  may  be  ready  to  enter  for  the  second  year's  work  together. 


THE   COURSE   OP  STUDY  39 

Second  or  Spring  Term 

Gynecological  Nursing 10 

Orthopedic  Nursing 10 

Operating- Room  Technic 10 

Obstetrical  Nursing 20 

Nursing  in  Diseases  of  the  Eye,  Ear,  Nose  and  Throat 10 

Total 60 

Senior  or  Third  Year 

First  or  Winter  Term 

Nursing  in  Mental  and  Nervous  Diseases 20 

Nursing  in  Occupational,  Venereal  and  Skin  Diseases 10 

Special  Therapeutics  (including  Occupation  Therapy) 10 

Public  Sanitation » 10 

Survey  of  the  Nursing  Field 10 

Total 60 

Second  or  Spring  Term 

Modern  Social  Conditions 10 

Professional  Problems 10 

Emergency  Nursing  and  First  Aid 10 

"Introduction  to  Public  Health  Nursing  and  Social 

Service 10  hours 

"Introduction  to  Private  Nursing 10  hours 

"Introduction  to  Institutional  Work 10  hours 

"Introduction  to  Laboratory  Work 10  hours 

"Housekeeping  Problems  of  Industrial  Families 10  hours 

"Special  Disease  Problems  (Advanced  work  in  any  of 

special  forms  of  disease  studied  above) 10  hours 

Total 60 

Total  number  of  hours  for  the  three  years — 585  to  595. 

The  outline  of  each  of  these  subjects  is  given  in  the  following  pages.  The 
subjects  are  classified  according  to  their  relationship  to  one  another  rather 
than  in  the  order  in  which  they  would  follow  one  another  in  the  curriculum. 
They  are  divided  into  the  main  fields  of  Biological  and  Physical  Science, House- 
hold Science,  Prevention  of  Disease,  Treatment  of  Disease,  Nursing  in  Dif- 
ferent Forms  of  Disease,  Social  and  Professional  Subjects  and  Special  Branches 
of  Nursing. 

*  The  subjects  starred  are  all  elective,  to  be  selected  according  to  the  stu- 
dent's future  line  of  work.  Each  student  would  be  expected  to  cover  at  least 
three  of  these  subjects,  to  make  up  a  total  of  60  hours  of  work  for  the  last  term. 


30 


OUTLINES  OF  SUBJECTS 

A.  BIOLOGICAL  AND  PHYSICAL  SCIENCES 

Anatomy  and  Physiology 

TIME:  60  hours,  divided  as  follows: 

Lectures  and  demonstrations  by  qualified  teacher  of  anat- 
omy, preferably  a  physician  or  trained  nurse  instructor,  30 
hours. 

Classes,  quizzes  and  individual  laboratory  work  conducted 
by  nurse  instructor,  30  hours. 

Course  to  be  given  (and  completed)  in  the  early  part  of  the 
first  year. 

OBJECTS  OF  THE  COURSE 

1.  To  give  the  pupil  a  practical  working  knowledge  of  the 
structure  and  function  of  the  normal  human  body  as  the  essen- 
tial basis  for  the  study  of  hygiene,  dietetics,  materia  medica, 
and  all  pathological  conditions,  as  well  as  for  the  safe  and  in- 
telligent practice  of  nursing  measures  in  the  wards. 

2.  To  discourage  popular,  haphazard  and  pseudo-scientific 
ways  of  thinking  about  the  body  and   its  functions,    to  give 
practice  in  the  correct  use  of  ordinary  scientific  terms,  to  train 
in  habits  of  exact  observation  and  reasoning  and  to  arouse  an 
intelligent  interest  in  scientific  work  generally. 

OUTLINE  OF  CLASSES  AND  LABORATORY  PERIODS 

I  and  III.  (Lectures  and  Demonstrations)  Introduction. 

Biological  functions  common  to  all  forms  of  life — Eight  biologi- 
cal systems — skeletal,  muscular,  alimentary,  vascular,  respi- 
ratory, excretory,  nervous,  reproductive.  Body  as  a  whole — 
cavities,  surface  anatomy,  location  of  organs.  The  cell  theory 
— cell  structure  and  activities.  Evolutionary  theory  (very 
briefly). 

II  and  IV.  (Laboratory  and  Quiz) 

Dissect  frog  of  larger  animal  to  show  body  as  a  whole.  Study 
simpler  animal  types — amoeba  and  paramecium  under  micro- 
scope. Show  slides  illustrating  cell-division  in  diderent  stages. 

V  and  VII.   (Lectures  and  Demonstrations)     Study  of  Tissues 

Embryonic  origin  of  tissues.  Four  elementary  tissues — epi- 
thelial, connective,  nervous,  muscular.  Glandular  tissue — flat 
and  columnar  cells,  tubular  glands,  branched  tubular  glands. 
Special  membranes — serous,  synovial,  mucous,  cutaneous. 

VI  and  VIII.  (Laboratory  and  Quiz) 

Charts  or  pictures  showing  folding  off  of  tissues  in  embryo. 
Students  make  slides  of  epithelial  tissue  from  the  lips.  Stain 
and  examine  under  the  microscope.  Draw.  Illustrate  dif- 

40 


ANATOMY  AND   PHYSIOLOGY  41 

ferent  tissues  by  meat  obtained  from  the  butcher  or  by  dis- 
secting small  animal ;  also  show  slides  under  microscope. 

IX  and  XI.  (Lectures   and   Demonstrations)    Skeletal   System 

Osseous  tissue — gross  and  microscopic.  Structure  of  bone. 
Regeneration  of  bone.  Study  of  skeleton — head,  trunk,  ex- 
tremities, articulations. 

X  and  XII.  (Laboratory  and  Quiz) 

Examine  and  sketch  slides  showing  longitudinal  and  trans- 
verse sections  of  bone.  Fresh  bone,  showing  articulations. 
Bone  treated  with  acid.  Quiz  on  skeleton  and  separate  bones 
to  be  studied  and  identified.  (X-rays  plates  very  helpful.) 

XIII  and  XV.  (Lectures  and  Demonstrations)     Muscular  System 

Muscular  tissue.  Mechanics  of  locomotion.  Muscular  fa- 
tigue. Study  of  more  important  muscles,  particularly  those 
involved  in  common  surgical  procedures. 

XIV  and  XVI.  (Laboratory  and  Quiz) 

Slides  showing  different  types  of  muscular  tissue.  Charts 
showing  different  types  of  levers.  Examination  of  fresh  meat. 
Rabbit  or  cat  dissection  for  muscles  and  tendons. 

XVII,  XIX,  XXI,  XXIII,  and  XXV.  (Lectures  and  Demonstrations) 
Alimentary  System 

Anatomy  of  alimentary  canal.  Anatomy  of  accessory  organs 
of  the  digestive  system — teeth,  tongue,  salivary  glands,  pan- 
creas, liver  and  gall-bladder.  Foods,  food  constituents,  body 
constituents,  food  values.  Digestion — mechanical,  chemical 
and  psychical  factors.  Absorption. 

XVIII,  XX,  XXII,  -XXIV  and  XXVI.  (Laboratory  and  Quiz) 

Charts,  models,  slides  and  fresh  specimens  of  animal  organs 
used  freely.  Government  charts  showing  food  values.  Dem- 
onstrate chemical  tests  in  digestion  and  absorption  of  foods, 
salivary  digestion,  gastric  digestion  and  saponification  of  fats 
and  oils.  X-ray  plates  showing  bismuth  meals.  (For  full 
directions  as  to  tests  see  Bigelow — Applied  Biology  and  Labora- 
tory Manual.) 

XXVII,  XXIX,  XXXI,  and  XXXIII.  (Lectures  and  Demonstrations) 
Vascular  System 

Blood-vascular  system — blood,  heart,  arteries,  veins  and 
capillaries.  General  circulation — pulmonary,  systemic  and 
pSrtal.  Control  of  local  circulation,  blood  pressure,  pulse. 
Lymph-vascular  system — lymph,  lymph-vessels. 

XXVIII,  XXX,  XXXII  and  XXXIV.  (Laboratory  and  Quiz) 

Show  charts,  models,  slides  and  diagrams.  Dissect  beef 
heart  with  vessels.  Students  make  slides  of  drop  of  their  own 
blood;  examine,  make  drawings.  Show  method  of  counting 
r.  b.  c.  and  leucocytes.  Effect  of  different  solutions,  tempera- 
tures, etc.  on  clotting.  Demonstrate  taking  blood-pressure. 
Pulse-tracings  in  normal  and  abnormal  cases.  Examine  foot  of 
live  frog  under  microscope  for  study  of  circulation  and  heart 
action  in  dead  frog.  Color  index  for  haemoglobin. 


42  OUTLINES   OF  SUBJECTS 

XXXV  and  XXVII.  (Lectures  and  Demonstrations)  Respiratory  System 

Anatomy  of  respiratory  organs.  Function  of  respiration. 
Mechanical  factors.  Effect  on  blood. 

XXXVI  and  X  CXVIII.  (Laboratory  and  Quiz) 

Examination,  inflation  and  dissection  of  beef  lungs,  includ- 
ing trachea  and  larynx.  Microscopic  study  of  lung  tissue. 
Demonstrate  mechanics  of  respiration.  Demonstrate  lung- 
motor.  Test  students'  lung  capacity. 

XXXIX,  XLI  and  XLIII.  (Lectures  and  Demonstrations)    Excretory 
System 

Anatomy  of  kidneys,  ureters,  bladder,  etc.  Physiology  of 
urinary  system.  Anatomy  and  physiology  of  the  skin.  (Pri- 
mary function  heat  regulation,  secondary  function  excretion.) 
Appendages  of  the  skin — hair  and  nails.  Body  temperature — 
normal,  abnormal.  Mechanism  of  heat  regulation. 
XL,  XLII  and  XLIV.  (Laboratory  and  Quiz) 

Dissect  sheep's  kidney.     Show  charts,  models,  slides,  etc.,  of 
kidney  and  skin.   Constituents  of  normal  urine  and  simple  tests. 
XLV.   (Lecture  and  Demonstration)     Ductless  Glands  and  Metabolism 
Structure  and  functions  of  suprarenal,  thyroid  and  pituitary 
glands.     Influence  of  internal  secretions  on  functions  of  the 
body.    Metabolism.     Anabolic  and  katabolic  changes. 
XLVI.  (Laboratory  and  Quiz) 

Examination  of  specimens  and  slides.  Review  of  digestion, 
excretion  and  metabolism. 

XLVII,  XLIX,  LI,  LIII,  LV.  (Lectures  and  Demonstrations)     Nervous 
System  and  Special  Senses 

Nervous  tissue.  Degeneration  and  regeneration  of  nervous 
tissue.  The  neurone,  the  spinal  cord,  spinal  nerves.  Reflex 
and  automatic  action.  The  brain — structure  and  function. 
Sensation.  Anatomy  and  physiology  of  special  sense  organs — 
ear,  eye,  organs  of  taste  and  smell. 
XLVIII,  XL,  LII,  LIV  and  LVI.  (Laboratory  and  Quiz) 

Charts,  models,  and  slides  of  brain,  cord  and  special  sense 
organs.    Dissection  of  fresh  pig's  head.     Dissection  of  pig's 
eye.     Drawings. 
LVIII,  LIX.  (Lectures  and  Demonstrations)     Reproductive  System 

Anatomy  of  female   generative  organs.     Review  of   pelvic 
bones.     Birth  canal.    Anatomy  of  male  generative  organs  and 
male  pelvis.     Physiology  of  the  reproductive  system. 
LVIII  and  LX.  (Laboratory  and  Quiz) 

Show  lantern  slides  or  charts  of  different  stages  in  develop- 
ment of  embryo.     Dissect  cat  or  rabbit  to  show  embryo  and  re- 
productive system  as  a  whole. 
METHODS  OF  TEACHING 

1.  In  the  lecture  periods,  groups  of  30  pupils  or  more  can  be 
handled,  but  for  laboratory  work,  smaller  groups  not  exceeding 
15  to  20  are  advisable. 


ANATOMY  AND   PHYSIOLOGY  43 

2.  It  is  important  to  have  pupils  themselves  handle  material 
and  carry  out  observations  and  experiments  as  far  as  at  all 
possible.    Laboratory  work  arouses  interest,  stamps  facts  in 
the  memory,  trains  in  careful  observation  and  clears  up  difficul- 
ties.    Clear  written  directions  should  be  given  for  all  laboratory 
exercises.     Pupils  can  often  work  in  groups  of  two  or  three, 
where  the  material  and  equipment  is  limited.     Note  books  of 
laboratory  work  should  be  kept  with  diagrams  and  drawings, 
descriptions  of  experiments,  etc.    These  should  be  handed  in 
for  inspection  at  regular  intervals. 

3.  Where  the  time  is  limited,  demonstrations  by  the  teacher 
may  take  the  place  of  some  of  the  laboratory  exercises.     Some 
teachers  advocate  the  observation  of  one  or  two  post-mortems 
for  pupils  in  anatomy  classes,  but  this  would  probably  come 
more  profitably  in  the  later  part  of  the  training. 

4.  Short  papers  on  special  topics  can  be  assigned  to  pupils 
in  turn,  and  read  in  class.    Oral  and  written  quizzes  and  reviews 
should  be  frequent. 

5.  Special  emphasis  should  be  laid  on  the  phases  of  the  sub- 
ject which  apply  to  nurses'  work.     The  close  connection  be- 
tween the  theoretical  and  the  practical  work  should  be  empha- 
sized, and  illustrations  should  be  used  constantly  by  the  in- 
structor to  form  a  close  association  between  the  two.     The 
work  here  should  also  be  correlated  with  parallel  courses  in 
chemistry,  bacteriology,  hygiene,  dietetics,  etc. 

6.  Good  blackboard  work  is  essential  here.    A  good-sized 
blackboard  and  colored  chalks  should  be  provided.    Students 
should  be  encouraged  to  use  diagrams  extensively  in  note-books 
and  should  also  learn  to  draw  on  the  blackboard. 

7.  A  good  text  book  should  be  used,  and  assignments  required 
regularly.    Other  readings  can  be  assigned  where  the  text- 
book needs  to  be  supplemented. 

8.  Take  students  to  a  good  Natural  History  Museum  if  pos- 
sible, to  show  comparison  between  human  anatomy  and  that 
of  other  animals;  also  to  show  cellular  structure  and  embryonic 
development. 

9.  It  is  not  expected  that  this  arrangement  of  topics  will 
suit  all  teachers.    Many  prefer  to  take  the  skeletal  and  muscu- 
lar systems  before  tissues,  some  introduce  the  nervous  system 
much  earlier  in  the  course,  and  some  take  the  circulatory  sys- 
tem before  the  digestive.     Such  readjustments  in  the  order 
of  topics  would  not  alter  the  general  character  of  the  course. 

EQUIPMENT  AND  ILLUSTRATIVE  MATERIAL 

Skeleton  with  separate  skull,  separate  bones;  compound  and 
dissecting  microscopes  (one  for  every  two  students  if  possible), 
colored  chalks,  charts,  slides  and  X-rays  plates;  papier-mache 
manikin  and  models  of  kidney,  sweat  glands,  eye,  ear,  etc. 


44  OUTLINES   OF   SUBJECTS 

Specimens  in  formalin — brain,  kidney,  spinal  cord,  larynx,  etc. 
Modelling  clay.  Excellent  home-made  charts  can  be  made  with 
manilla  paper  and  wax  crayons,  or  with  Bristol  board  and  paints 
or  water  colors. 

MATERIALS  TO  BE  KEPT  IN  CLASS-ROOM  (for  a  group  of  12) : 

Two  trays,  6  dissecting  pans  with  paraffin  (squares  of  soft 
wood  may  be  used  instead  of  paraffin  pans);  flat  glass  dishes; 
6  finger  bowls;  6  small  glass  jars;  12  dissecting  needles;  paper 
pins  (small);  bank  pins;  8-in.  square  gauze;  6  glass  stoppered 
bottles;  6  Bunsen  burners;  6  tripods;  6  wire-screens;  3  small 
alcohol  lamps;  slides;  cover  slips;  glass  covered  jars  for  speci- 
mens; labels;  3  red  wax  pencils;  3  doz.  text-tubes,  6  glass  fun- 
nels (2  sizes);  filter  paper  (2  sizes);  6  sets  of  beakers  (4  in  set) 
6  funnel  racks;  6  test-tube  racks;  6  test-tube  holders;  stickers; 
cotton  thread;  No.  36;  dishes  for  specimens;  3  casseroles;  2 
mortars  and  pestles;  litmus  paper;  HC1  0.2  per  cent,  HC1  10 
per  cent;  Fehling-Benedict  solution;  Filter  paper;  Iodine; 
NaOH;  Alcohol;  6  glass  stirring  rods;  6  pipettes;  6  scalpels; 
6  pr.  scissors  (those  discarded  from  operating  room  may  be 
used,  or  scissors  may  be  bought  at  the  ten  cent  store);  10 per 
cent  formalin. 

TEXT  AND  REFERENCE  BOOKS 

Kimber:  Anatomy  and  Physiology  for  Nurses. 

Pope:  Anatomy  and  Physiology  for  Nurses. 

Dawson:  Anatomy  and  Physiology  for  Nurses 

Bundy:  'Anatomy  and  Physiology. 

Howell:  Text-book  of  Physiology. 

Starling:  Principles  of  Human  Physiology. 

Tigerstedt:  Text-book  of  Physiology. 

Hough  and  Sedgwick:  Human  Mechanism. 

Martin:  Human  Body. 

Bigelow:  Applied  Biology. 

Halliburton:  Hand-book  of  Physiology. 

Brubaker:  Anatomy  and  Physiology. 

Hertar:  Biological  Aspects  of  Human  Problems. 

Cannon:  Mechanical  Factors  in  Digestion. 

Cannon:  Bodily  Changes  in  Pain,  Hunger,  Fear  and  Rage. 

Parker  and  Parker:  Practical  Zoology. 

Parker  and  Haswell:  Text-book  of  Zoology. 

Gray:  Anatomy. 

Gcrrish:  Anatomy. 

Sabotta-McMurrich:  Atlas  and  Text-book  of  Human  Anatomy. 

Marshall:  Vertebrate  Embryology. 

Wiedersheim :  Comparative  Anatomy. 

Piersol:  Normal  Histology. 


BACTERIOLOGY  45 

Hill:  Histology. 

Stiles:  Nutritional  Physiology. 

Sherman:  Chemistry  of  Food  and  Nutrition. 

Elementary  Bacteriology 

TIME:  20  hours — arranged  as  follows: 

Lecture,  demonstration,  and  recitation  10  hours. 

Laboratory  work — 10   hours.     (Laboratory   period   to   follow 

class  period.) 

Taught  by  a  physician  with  nurse  assistant,  or  by  trained 
nurse  instructor.  The  course  to  be  given  early  in  the  pre- 
paratory year. 

OBJECTS  OF  COURSE 

1.  To  help  pupils  to  understand  the  characteristics  and  hab- 
its of  microorganisms,   so  that  they  may  be  better  able  to 
protect    themselves,    their    patients,    and    the    public    from 
infection. 

2.  To  teach  them  something  of  laboratory  technic  so  that 
they  will  appreciate  better  the  necessity  for  surgical  asepsis, 
and  learn  to  apply  the  same  careful  methods  in  their  nursing 
procedures,  cleaning,  cookery,  etc. 

3.  To  arouse  interest  in  this  new  and  very  important  branch 
of  science,  so  that  the  pupils  will  continue  to  read  and  study 
along  these  lines,  and  keep  up-to-date  in  the  latest  discoveries 
and  methods. 

OUTLINE  OF  CLASSES  AND  LABORATORY  WORK 

I.  (Class)    Introduction 

Uses  of  bacteriology  to  the  nurse.  Historical  theories  of  dis- 
ease. Leaders  in  science  of  bacteriology — Pasteur,  Koch,  Er- 
lich,  etc.  (very  briefly).  Consideration  of  plants — green  and 
colorless.  Eight  biological  systems  of  higher  animals  and 
parallel  functions  of  one-celled  organisms.  Structure  of  typi- 
cal plant  and  animal  cells.  Independent  plants.  Economic 
and  biological  functions  of  green  plants.  Photo-synthesis, 
respiration  and  transpiration.  Reproduction  by  mitosis. 
Conditions  favoring  growth. 

II.  (Laboratory)  The  microscope — how  to  use  it  and  care  for  it. 
Demonstration  showing  osmosis.  Study  of  onion  epidermis  to 
show  cell  structure  and  plasmolysis.  Microscopic  study  show- 
ing cell  structure  of  leaves.  Experiments  showing  photo- 
synthesis, respiration  and  transpiration. 
III.  (Class)  Molds 

Dependent  plants — molds,  parasitic  and  saprophytic  organ- 
isms. Economic  relationships.  Mold  diseases.  Distribution 
of  molds.  Structure.  Reproduction' — sexual  and  asexual, 


46  OUTLINES  OF  SUBJECTS 

spore  formation.     Conditions  favoring  growth  and  methods  of 
destruction. 

IV.  (Laboratory)    Study  of  two  or  three  common  molds  under 
microscope  with  drawings.    Making  of  pure  cultures  of  mold 
by  inoculating  sterile  bread  or  crackers  with  a  selected  mold. 
V.  (Class)     Yeasts 

Economic  relationships.  Structure.  Reproduction  by  bud- 
ding, fission  and  spores.  Enzyme  action.  Fermentation. 
Work  of  Pasteur.  Conditions  favoring  growth.  Methods  of 
destruction. 

VI.  (Laboratory)  Observation  and  drawing  of  yeast  cells  and 
starch  grains.  Technic  of  the  hanging  drop.  Experiment  to 
show  effect  of  different  temperatures  on  growth  and  viability 
of  yeast  or  experiment  to  show  ability  of  yeast  to  ferment 
various  carbohydrates. 
VII.  (Class)  Bacteria 

Distribution  of  bacteria.  Structure  of  bacterial  cell.  Clas- 
sification according  to  morphology  and  grouping.  Methods  of 
reproduction  by  fission  and  by  spore  formation.  Conditions 
affecting  growth — temperature,  moisture,  food  supply,  light, 
oxygen.  Effect  of  electricity,  chemicals,  agitation,  etc.  Vital 
phenomena — odor,  motility,  light,  heat,  pigment,  etc.  Special 
media  for  laboratory  study  of  bacteria. 

VIII.  (Laboratory)  Exhibit  of  various  laboratory  media.  Descrip- 
tion of  culture  growth.  Making  of  agar  pour  plate  and  exposing 
to  various  conditions  as  air,  hair,  fly,  washed  and  unwashed 
fingers,  etc.  Use  of  oil  immersion  lens.  Preparation  and  ex- 
amination of  stained  smear  of  bacteria  from  teeth.  Examina- 
tion of  prepared  slides  of  staphylococci,  streptococci,  and 
bacilli  for  morphology. 

IX.  (Class)  Effects  of  Physical  and  Chemical  Agents  on  Micro- 
organisms 

Methods  of  destroying  bacteria.  Physical — by  dry  and  moist 
heat,  sunlight,  etc.  Chemical — by  germicides  and  antiseptics. 
Length  of  exposure  for  bacteria  and  spores.  Effects  of  strength 
and  temperature  of  chemical  agents  on  bacteria. 
X.  (Laboratory)  Examination  of  cultures  from  Lesson  VIII. 
Making  pure  culture  by  fishing  and  transferring  to  broth  cul- 
ture. Testing  results  of  common  physical  and  chemical  agents 
on  bacteria. 

XI.  (Class)    Bacteria  and  Disease 

Disease  production  by  toxins,  endotoxins,  and  ptomaines. 
Avenues  of  entrance  into  body  of  bacteria.  Growth  in  tissues. 
Avenues  of  discharge.  Special  study  of  the  colon  and  typhoid 
groups  of  bacteria. 

XII.  (Laboratory)     Examine  broth  culture  from  laboratory  X  for 
characteristic  growth  of  organisms  in  broth.    Make  streak  cul- 


BACTERIOLOGY  47 

ture   on   agar   slant.     Demonstration   of   plating   method  in 
examination  of  water. 

XIII.  (Class)     Dissemination  of  Disease-Producing  Organisms 

Transmission  of  disease  by  direct  and  indirect  contact.  The 
r61e  of  insect  carriers,  human  carriers,  fomites,  water,  shell- 
fish, milk  and  other  foods,  air  and  "filth."  Special  study  of 
staphylococcus,  streptococcus,  pneumococcus  and  filterable 
viruses. 

XIV.  (Laboratory)    Examination  of  streak  cultures  from  laboratory 
XII  to  identify  organisms,  purity  of  colonies,  etc.     Prepara- 
tion and  examination  of  slides  of  streptococcus,  staphylococcus 
and  pneumococcus.    Making  cultures  of  water  and  milk. 

XV.  (Class)     Bacteriology  of  Milk  and  Water 

Relation  of  bacteria  to  milk  supply.  Sources  of  bacterial 
infection  in  milk.  Methods  of  safe-guarding  milk  supply. 
Water  as  a  medium  of  infection.  Sources  of  contamination. 
Tests  for  water  and  milk  supplies. 

XVI.  (Laboratory)    Examination  of  cultures  of  water  and  milk  and 
estimation  of  number  to  cubic  centimeters  of  water  or  milk 
tested.     (Visit  to  Board  of  Health  Laboratory  if  possible.) 
XVII.  (Class)    Defences  of  the  Body  Against  Pathogenic  Bacteria 

External  defences  of  the  body.    Vital  resistance  and  factors 
modifying  it.     Theories  of  immunity,  antibodies,  phagocytes, 
etc.    Vaccination.    Use  of  antitoxines  and  sera.    Special  study 
of  tubercle,  Klebs-Loffler,  tetanus  and  anthrax  bacilli.    Prepa- 
ration of  sera  and  vaccines.     (Seen  in  laboratory  if  possible.) 
XVIII.  (Laboratory)    Hanging  drop  showing  motility  and  agglutina- 
tion.   Examination  of  prepared  slides  of  bacilli  given  special 
study  in  class,  also  slides  showing  phagocytosis. 
IX.  (Class)    Applications  of  Bacteriology 

Applications  of  above  principles  to  methods  of  disinfection, 
to  sterilization  of  water,  instruments,  dressings,  to  care  of  dis- 
charges and  excretions.  Applications  of  bacteriology  and  se- 
rum-therapy in  prevention,  diagnosis  and  treatment  of  small- 
pox, typhoid,  fever,  diphtheria,  syphilis,  rabies,  etc.  Special 
study  of  organisms  causing  malaria,  syphilis  and  gonorrhoea. 
XX.  (Laboratory)  Demonstration  of  the  taking  of  throat  cultures. 
Preparation  and  examination  of  smears  from  throat.  Examina- 
tion of  prepared  slides  showing  organisms  discussed  in  class. 

METHOD  OF  TEACHING 

1.  Follow  class  method  for  presentation  of  subject  matter  as 
far  as  possible.     Have  outside  readings  and  reports  from  as- 
signed books  or  current  journals. 

2.  Laboratory  work  to  be  given  in  sections,  not  exceeding 
15  to  20  students  with  facilities  for  each  pupil  or  pair  of  pupils 
carrying  out  all  the  experiments.    Note-books  for  drawings  and 
laboratory  notes. 


48  OUTLINES   OF  SUBJECTS 

3.  Correlate  as  closely  as  possible  with  other  subjects,  espe- 
cially with  hygiene  and  practical  nursing  work.     A  short  paper 
on  "The  Practical  Applications  of  Bacteriology  to  Nursing" 
will  help  to  focus  attention  on  the  uses  of  the  subject. 

4.  No  one  text  book  for  nurses  covers  the  ground  adequately. 
Choose  the  best  and  supplement  liberally  from  larger  reference 
books.     Recent  editions  of  text  and  reference  books  should  be 
used,  as  changes  are  constantly  taking  place  in  this  subject. 

5.  Have  at  least  one  visit  to  a  well-equipped  laboratory  such 
as  might  be  found  in  the  Board  of  Health — or  the  hospital  itself. 

EQUIPMENT  AND  ILLUSTRATIVE  MATERIAL 

Microscopes — (one  for  every  two  students  if  at  all  possible), 
petri  dishes,  test  tubes,  fermentation  tubes,  slides  (plain  and 
prepared),  racks  for  drying  slides,  cover  slips,  stains,  oil,  balsam, 
lens  paper,  platinum  needles,  bunsen  burners,  tripods,  pipettes, 
etc.  Small  utensil  sterilizer,  culture  media  and  cultures  from 
pathological  laboratory.  Charts,  photographs  and  slides. 

Room  should  be  fitted  up  with  tables  or  shelves  where  mi- 
croscopes can  be  placed  in  good  light.  Should  also  have  gas 
and  running  water  attachments. 

TEXT  AND  REFERENCE  BOOKS 

Conn:  Bacteria,  Yeasts  and  Molds  in  the  Home. 

Bolduan  and  Grund:  Applied  Bacteriology  for  Nurses. 

Roberts:  Bacteriology  and  Pathology  for  Nurses. 

Fox:  Bacteriology  and  Protozoology. 

Buchanan:  Household  Bacteriology. 

Curtis:  Nature  and  Development  of  Plants. 

Bigelow:  Applied  Biology. 

Conn:  Agricultural  Bacteriology. 

Hiss  and  Zinnser:  A  Text  Book  on  Bacteriology. 

Park  and  Williams:  Pathogenic  Micro-Organisms. 

Jordan:  General  Bacteriology. 

Zinnser:  Infection  and  Resistance. 

Chapin:  The  Sources  and  Modes  of  Infection. 

Marshall:  Microbiology. 

Rosenau:  Preventive  Medicine  and  Hygiene. 

Gibson:  Clinical  Laboratory  Technic. 

Carey:  A  Text-book  for  Nurses  in  BacteriologE. 

Applied  Chemistry. 

TIME:  20  hours  divided  as  follows: 

Lecture  and  class-work — 10  hours. 
Laboratory  work  and  demonstrations — 10  hours. 
Taught  by  the  instructor  of  nurses  or  a  teacher  of  chemistry 
(secured  from  a  high  school  or  college) — Course  to  be  given 
early  in  the  preparatory  year. 


CHEMISTRY  49 


OBJECTS  OF  COURSE 


1.  To  serve  as  a  basis  for  the  more  intelligent  study  of  physi- 
ology, dietetics,  household  economy,  materia  medica,  and  other 
nursing  subjects. 

2.  To  make  the  pupil  nurse  more  observant  of  the  chemical 
phenomena  of  every-day  life,  especially  those  chemical  reac- 
tions which  are  of  practical  and  economic  importance  in  nurs- 
ing and  hospital  work. 

3.  To  train  her  to  be  skillful  and  accurate  in  handling  labora- 
tory material  and  to  be  exact  in  her  reasoning. 

4.  Where  pupils  have  already  had  a  good  course  in  chemistry, 
the  special  applications  of  chemistry  to  nursing  can  be  enlarged 
upon  and  the  general  principles  of  organic  and  inorganic  chem- 
istry reviewed. 

NOTE  :  It  is  highly  desirable  that  all  pupils  should  be  required 
to  have  covered  a  good  elementary  course  in  chemistry  before 
admission  to  nursing  schools.  It  is  quite  impossible  to  teach 
a  subject  of  this  kind  in  20  hours.  All  one  can  hope  to  do  is  to 
give  a  few  foundation  principles,  and  a  few  practical  applica- 
tions in  this  time. 

OUTLINE  OF  CLASSES  AND  LABORATORY  WORK 

I.  (Lecture  and  Class)  Introduction 

Relation  of  chemistry  to  animal  life.  Changes  involved  in 
life  processes.  Relation  to  plant  life.  Classes  of  changes — 
physical  and  chemical.  Definitions  of  physics,  chemistry,  etc. 
Factors  in  all  energy  changes — matter  changes — mechanical 
mixtures — chemical  compounds — elements. 
II.  (Laboratory) 

Construction  of  simple  laboratory  apparatus  and  experiments 
showing  physical  and  chemical  changes. 

III.  (Lecture  and  Class)  Elements  and  Chemical  Formulae  and  Equa- 
tions 

Definition  of  elements — occurrence,  physical  states,  names 
and  symbols  of  those  in  most  general  use.  Dalton's  Atomic 
Theory.  Valence.  Molecules.  Uses  of  formulae  and  equa- 
tions. Study  of  formulae  of  compounds  in  most  general  use. 

IV.  (Laboratory)  Mechanical  and  chemical  compounds.    Physical 
processes.    Dissolving — true  solution  and  saturated  solution. 
Distillation  (to  be  given  as  a  demonstration). 

V.  (Lecture  and  Class)    Oxygen 

Occurrence,  properties,  importance  to  life.  Oxidation. 
Measuring  of  food  value  in  terms  of  calories.  Oxidizing  and 
reducing  agents.  Compounds  of  oxygen.  Carbon  dioxode. 
Carbon  monoxide.  Water.  Impurities  of  water — hard  and 
soft.  Fire  extinguishers. 


50  OUTLINES  OF  SUBJECTS 

VI.  (Laboratory)    Experiments  in  preparation  of  oxygen,  showing 
combustion.     Determination    of    carbon    dioxide.     Tempera- 
ture.    Scales  for  measuring.     Freezing  and  boiling  points. 
VII.  (Lecture  and  Class)    Acids 

Composition.  Brief  talk  on  properties  of  hydrogen.  Non- 
metals — their  classification.  The  acid  radical.  Formulae  of 
acids  in  most  common  use.  Characteristics  of  acids.  Classi- 
fication of  acids  into  binary  acids,  oxy-acids  and  halogen  acids. 
Action  of  acids  on  tissues. 

VIII.  (Laboratory)     Test  for  characteristics  of  acids — taste,  litmus 
reaction,  reaction  with  zinc,  reaction  with  carbonates.    Tests 
for  the  presence  of  hydrogen. 
IX.  (Lecture  and  Class)     Bases 

Composition.     Mention  of  some  of  the  most  important  met- 
als.    Hydroxyl  group.     Definition  of  alkali.     Characteristics 
of  bases.     Classification  of  bases.     Neutralization. 
X.  (Laboratory)     Composition   and   preparation   of   lime   water. 
Test  for  characteristics  of  bases,  litmus  reaction,  taste,  feeling, 
neutralization. 
XI.  (Lecture  and  Class)    Salts 

Classification  of  salts.  Normal  or  neutral  salts.  Salts  of 
binary  acids,  oxy-acids,  hypo-ous  acids.  Importance  of  salts 
to  the  body.  Uses  of  normal  saline.  Brief  discussion  of  salts 
used  medicinally.  Classification.  Chlorides.  Sulphates. 
Phosphates.  Halogen  salts.  Functions  of  special  salts — cal- 
cium, etc. 

XII.  (Laboratory)  Experiments  to  show  effect  of  distilled  water  on 
blood.  Test  for  reaction  of  salts — sodium  chlorides,  sodium 
bicarbonates,  acid  sodium  phosphates,  etc.  Tests  for  presence 
of  chlorides,  sulphates,  phosphates,  etc. 

XIII.  (Lecture  and  Class)     Introduction  to  Organic  Chemistry 

Definition.  Constituents  of  organic  compounds.  Distribu- 
tion of  carbon.  A  few  of  the  compounds  of  carbon.  Organic 
acids — their  classification.  Properties  similar  to  inorganic 
acids.  Organic  bases.  Alcohols  and  alkaloids.  Organic  salts. 

XIV.  (Laboratory)     Experiments  to  show  constituents  of  organic 
matter.     Tests  for  presence  of  carbon,  hydrogen,  nitrogen,  sul- 
phur, phosphorus,  etc.     Tests  for  presence  of  alkaloids. 

XV.  (Lecture  and  Class)     Carbohydrates 

Molecular  construction.  Classification  into  monosaccharids, 
di-saccharids  and  poly-saccharids.  Their  solubility,  digestibil- 
ity, properties  and  occurrence.  Digestion  of  carbohydrates. 
XVI.  (Laboratory)  Test  for  presence  of  glucose.  Determination  of 
the  composition  of  di-saccharids  and  poly-saccharids.  Deter- 
mination of  elemental  composition  of  carbohydrates.  Salivary 
digestion.  Hydrolysis.  Fermentation.  Osmosis. 


CHEMISTRY  51 

XVII    (Lecture  and  Class)     Proteins 

Nitrogen  and  some  of  its  compounds  (very  briefly  discussed). 
Molecular  construction  of  proteins.  Classes  of  proteins — 
where  found.  Digestion  of  proteins.  End  waste  products  of 
protein  metabolism. 

XVIII.  (Laboratory)    Tests  for  presence  of  protein.     Nitric  acid  test. 
Biuret,    precipitation    test.     Coagulation   test   for   albumen. 
Determination  of  nitrogen  as  ammonia.    Preparation  of  pro- 
teose  and  peptone.    Test  for  urea. 
XIX.  (Lecture  and  Class)     Fats 

Use  of  fats  to  the  body.  Caloric  value  of  fats.  Molecular 
construction.  Fatty  acids.  Emulsions.  Soaps.  Alcohols. 
XX.  (Laboratory)  Experiments  showing  solubility  of  fats  in  water, 
alcohol,  ether.  Determination  of  glycerine.  Extraction  of  pure 
fat  from  beef  suet.  Saponification  with  an  alkali.  Emulsifica- 
tion  (Cod  liver  oil  and  NaC03).  Separation  of  fatty  acids. 

METHODS  OF  TEACHING 

1.  It  is  impossible  to  teach  chemistry  by  the  lecture  method 
alone.     Discussions  and  frequent  quizzes  are  necessary  to  clear 
up  the  difficult  points  and  the  demonstration  of  experiments  is 
essential  to  any  clear  understanding  of  the  simplest  principles 
of  chemistry.    As  far  as  at  all  possible  each  individual  should 
be  able  to  work  out  her  own  experiments  in  the  laboratory. 
Where  this  is  not  possible  a  good  deal  can  be  accomplished 
through  demonstrations  by  the  teacher. 

2.  In  the  laboratory  stress  is  placed  on  the  care  with  which 
experiments  are  set  up,  and  on  the  keenness  of  observation,  the 
accuracy  of  records  and  conclusions  to  be  drawn.     Before  pass- 
ing on  to  another  experiment,  each  student  is  quizzed  by  the 
instructor  to  be  sure  that  she  understands  thoroughly  what  she 
has  done,  and  connects  it  with  her  notes. 

3.  Not  more  than  16  to  20  can  be  taken  together  in  a  labora- 
tory section,  unless  one  has  unusual  facilities.    Students  may 
often  work  in  groups  of  two. 


EQUIPMENT 


1.  The  room  for  the  laboratory  work  should  be  well  venti- 
lated and  fitted  with  a  hood  for  carrying  away  odors  of  disagree- 
able gases.     This  last  is  not  indispensable.    A  large  stationary 
table  with  drawers  and  cupboards  for  each  student,  fitted  with 
running  water  and  gas  burners,  is  desirable,  though  one  can 
manage  with  one  sink  and  alcohol  lamps. 

2.  Apparatus,  provided  for  laboratory  groups  of  12  pupils 
working  in  pairs  (cost  is  approximate  only) :  6  500  cc.  flasks, 
$3.15  per  dozen,  6  two-hole  rubber  stoppers  No.  5  at  15  cents 
each,  6  thistle  tubes  at  25  cents  each,  1  pound  glass  tubing, 


52  OUTLINES  OF  SUBJECTS 

3/16  (25  2-foot  length)  at  $1.10  pound,  6  ignition  tubes  at  10 
cents  each,  6  rubber  stoppers,  No.  1,  at  92  cents  dozen,  12  wide 
mouth  bottles  at  11  cents  each,  6  cake  tins  at  10  cents  each,  6 
deflagrating  spoons  at  45  cents  each,  12  watch  glasses  at  $2.00 
per  100,  scales  and  weights  $10.50,  6  porcelain  crucibles  with 
cover,  at  40  cents  each,  6  evaporating  dishes  (2  oz.)  at  $3.00  per 
dozen,  6  asbestos  mats  at  25  cents  each,  6  retort  stands  (three 
rings)  at  $1.35  each,  3  dozen  test  tubes  at  $3.15  per  gross,  6  test 
tube  holders  at  32  cents  each,  6  test  tube  racks  at  90  cents  each, 
6  glass  stirring  rods  at  40  cents  dozen,  1  file  (triangular)  at  50 
cents,  6  horn  spoons  (4^  in.)  at  $1.50  dozen,  6  pipettes  at  5  cents 
each,  1  nest  beakers  at  $2.25  nest,  3  graduates  (10  cc.)  at  46 
cents  each,  3  graduates  (50  cc.)  at  96  cents  each,  filter  paper 
(4  in.)  at  11  cents  package,  3  mortars  and  pestles  at  60  cents 
each,  6  funnels  (3  in.)  at  35  cents  each,  12  test  tube  brushes  at 
65  cents  dozen,  1  Centigrade  thermometer  at  $1.67. 

TEXT  AND  REFERENCE  BOOKS 

McPherson  and  Henderson:  Elementary  Study  of  Chemistry. 

Vulte:  Household  Chemistry. 

Asher :  Chemistry  and  Toxicology  for  Nurses. 

Bliss  and  Olive:  Chemistry  for  Nurses. 

Amoss:  Chemistry  for  Nurses. 

Pope :  Physics  and  Chemistry  for  Nurses. 

Lynde:  Household  Physics. 


B.  HOUSEHOLD  SCIENCE 

Nutrition  and  Cookery 

TIME:  40  hours,  given  in  20  two-hour  periods,  each  period  to  include  class, 
demonstration  and  laboratory  work.  Class  to  be  conducted  by 
a  trained  dietitian.  Course  to  be  given  in  the  first  term  of  the 
Preparatory  Year. 

OBJECTS  OP  COUBSE 

1.  To  give  pupils  a  good  fundamental  understanding  of  the 
principles  and  methods  of  simple  cookery  for  well  and  sick 
people. 

2.  To  make  them  familiar  with  the  nutritive  values  of  foods, 
and  help  them  to  arrange  a  balanced  dietary  for  well  people 
or  convalescents  according  to  the  demands  of  age,  physical  ac- 
tivity, climate,  etc. 

3.  To  help  them  to  understand  and  administer  the  ordinary 
hospital  diets.     (Dietary  treatment  of  particular  diseases  to 
come  later.) 

OUTLINE  OF  CLASSES 

I.  (Class)    Introduction 

Definition  of  food.  Chemical  composition  of  the  body  and 
of  food.  Classification  of  foods,  according  to  sources  (animal, 
vegetable,  and  mineral)  and  according  to  chemical  composi- 
tion (proteins,  carbohydrates,  fats,  mineral  salts  and  water). 
Function  of  each  of  these  in  the  body. 

(Laboratory)    The  diet  kitchen  and  its  equipment.     Care  of 
utensils  and  apparatus,   sinks,   refrigerators,   etc.    Study  of 
stoves  and  fuels.    Uses  of  each  kind. 
II.  (Class)    Digestion 

Review  of  the  digestive  system,  and  processes  of  digestion, 
absorption,  assimilation,  excretion  and  metabolism.  Effect  of 
methods  of  cooking  and  preservation  of  food  on  digestion. 

(Laboratory)     Temperatures  and  methods  of  cooking  and 
their  effect  on  food  stuffs  (baking,  boiling,  broiling,  frying, 
etc.).    Handling  of  utensils — measuring  and  weighing. 
III.  (Class)     Fuel  Values  in  Foods 

Basis  of  measurement  of  fuel  values.  The  body  requirement 
in  health  according  to  variations  of  sex,  age,  weight,  activity, 
climate,  etc.  General  variation  in  illness.  How  to  compute 
the  caloric  value  of  different  kinds  of  foods. 

(Laboratory)  Practice  in  measuring  out  100-calorie  portions 
of  common  carbohydrates,  sugars,  fats  and  proteins.  (Metric 
system.) 

53 


64  OUTLINES  OF  SUBJECTS 

IV.  (Class)     Building  Materials  in  Foods 

Basis  of  measurement  of  protein  in  foods.  The  body  require- 
ment of  protein  according  to  sex,  age,  weight,  activity,  etc. 
Variations  in  illness.  How  to  compute  the  protein  content  of 
common  foods.  Comparison  of  digestibility  and  costs.  Body 
requirement  in  mineral  salts  and  water. 

(Laboratory)     Practice  in  weighing  and  computing  protein 
content  of  foods,  also  mineral  salts  and  water. 
V.  (Class)     Preparation  and  Serving  oj  Foods 

General  principles  in  the  feeding  of  sick  people.  Selection 
of  food,  preservation  and  handling,  considerations  of  taste, 
variety,  digestibility,  appearance,  nutritive  value  and  economy. 
Table  and  tray  equipment  for  serving  food — dishes,  linen,  sil- 
ver, decorations,  etc.  Principles  of  tray  service.  The  con- 
valescent table. 

(Laboratory)     Practice  in  setting  table  and  tray  for  break- 
fast, dinner,  luncheon,  and  light  diet. 
VI.  (Class)     Beverages 

Place  of  water  and  beverages  in  the  dietary.  Sources,  varie- 
ties, composition  and  preparation  of  stimulating  and  acid  bev- 
erages. Mineral  waters — uses,  kinds  and  methods  of  serving. 

(Laboratory)    P  ac  ice  in  preparing  and  serving  tea,  coffee, 
cocoa,  fruit  drinks,  wines  and  mineral  waters. 
VII.   (Class)     Cereals,  Gruels  and  Starchy  Drinks 

Composition  and  food  value  of  common  cereal  foods.  Cook- 
ery of  starches,  especially  breakfast  cereals  and  gruels,  with 
special  reference  to  digestibility. 

(Laboratory)    Various  preparations  of  oatmeal,  wheat,  hom- 
iny, rice,  barley,  etc.     Starchy  beverages. 
VIII.  (Class)     Vegetables 

Composition  and  fold  value  of  common  legumes,  roots  and 
green  vegetables.  Selection,  preparation  and  cooking. 

(Laboratory)    Practice  in  preparation  of  potatoes,  spinach, 
beans,  cauliflower,  celery,  etc. 
IX.   (Class)     Fruits  and  Sugars 

Composition,  sources,  kinds  and  food  value  of  common  fruits 
and  sugars.  Selection,  preparation  and  cooking. 

(Laboratory)     Preparation    of    common    fresh,    dried    and 
canned  fruits. 
X.  (Class)     Fats  and  Oils — Salads 

Place  of  fats  in  the  dietary.  Comparison  of  animal  and 
vegetable  fats.  Use  of  fats  in  cooking.  Food  value  of  nuts. 
Varieties  of  salads  and  salad  dressings. 

(Laboratory)     Practice  in  making  fruit  and  vegetable  sal- 
ads and  salad  dressings. 
XI.  (Class)    Protein  Foods— Milk 

Milk  as  a  food.  Its  production  and  handling.  Principles 
observed  in  the  cooking  of  milk.  Combinations  of  milk  with 


NUTRITION  AND   COOKERY  55 

cereals  and  vegetables.    Forms  of  serving  raw  milk.    Principles 
of  pasteurization. 

(Laboratory)     Preparation  of  milk  soups,  milk  gruels,  milk 
shakes,  milk  punches.     Pasteurized  milk. 
XII.  (Class)    Special  Milk  Products 

Source  and  food  value  of  cream,  butter,  cheese,  curds  and 
whey.  Composition  and  preparation  of  milk  powder,  con- 
densed milk,  malted  and  peptonized  milk.  Lactic  acid  prepa- 
rations. 

(Laboratory)     Preparation  of  junket,  cottage  cheese,  whey, 
peptonized  milk,  koumiss  and  buttermilk. 
XIII.  (Class)     Eggs 

Composition,  food  value  and  digestibility  of  eggs.  Tests  for 
freshness.  Effects  of  temperature.  Combinations  of  eggs  with 
milk,  cereals,  fruit  juices,  etc. 

(Laboratory)     Preparation  of  baked,  boiled,  scrambled  and 
poached  eggs,  omelet,  custards,  egg-nogs,  and  albumen  water. 
XIV  and  XV.  (Class)    Meats  and  Poultry. 

Composition,  structure,  food  value  and  digestibility  of 
meats.  Different  cuts  and  organs  used  as  food.  Tests  for 
freshness.  Effects  of  temperature.  Methods  for  extraction 
and  retention  of  juices.  General  principles  of  carving  meat 
joints  and  fowl. 

(Laboratory)     Preparation    of    roast,    broiled    and    stewed 
meats,  poultry  broth,  beef  juice  and  scraped  beef.     Carving. 
XVI.  (Class)     Fish,  Mollusks  and  Crustaceans 

Classes  of  fish  goods,  composition,  food  value  and  digesti- 
bility. Tests  for  freshness.  Special  dangers  of  shell  fish. 

(Laboratory)    Preparation  of  baked,  boiled  and  fried  fish, 
oysters  and  clam  stews  and  broths,  lobster. 
XVII.  (Class)     Gelatines  and  Frozen  Desserts 

Composition,  sources  and  food  value  of  gelatine.  Effect  of 
freezing  on  foods.  Principles  of  freezing  mixtures. 

(Laboratory)     Preparation  of  gelatine  alone  and  in  combina- 
tion with  other  foods.     Preparation  of  ice  creams  and  sherbets. 
XVIII.  (Class)    Breads  (Leavening  Agents) 

Composition,  food  value  and  digestibility  of  various  kinds  of 
breads.  Leavening  agents — such  as  yeasts,  baking  powders,  etc. 
and  their  action. 

(Laboratory)     Making  bread  and  rolls,  biscuits,  sponge  cake, 
gluten  bread,  etc.     Toast  and  sandwiches. 
XIX  and 

XX.  (Class)    Hospital  Diets 

Classes  of  patients  in  hospital  requiring  specialized  diet. 
Modification  of  regular  diet  for  children,  adolescents  and  the 
aged,  also  for  chronics,  convalescents,  etc.  Types  of  hospital 
diets — fluid,  light,  nitrogenous,  farinaceous,  milk,  etc. 


66  OUTLINES   OF   SUBJECTS 

(Laboratory)  Making  of  menus  for  typical  patients — not 
acutely  ill.  Preparation  and  serving  of  complete  meals,  repre- 
senting balanced  normal  diet  and  various  types  of  special  hos- 
pital diets. 

METHOD  OP  TEACHING 

1.  The  most  satisfactory  method  is  the  combination  of  class, 
demonstration  and  laboratory  in  lessons  of  from  two  to  three 
hours  each.     The  pupils  then  have  a  chance  to  tie  up  their  prin- 
ciples directly  with  their  practice,  and  to  carry  out  their  cook- 
ing procedures  when  the  demonstration  and  discussion  are 
fresh  in  mind  and  when  they  are  under  direct  supervision.     The 
number  in  the  class  should  not  exceed  20  pupils.     Regular  diet 
kitchen  experience  would  follow  such  a  course  of  class  and  lab- 
oratory work,  and  the  pupil  would  then  be  able  to  proceed  with 
little  additional  instruction. 

2.  If  such  a  method  is  impossible,  classes  and  demonstrations 
could  be  held  by  the  dietitian,  and  the  applications  made  later 
when  the  pupil  has  her  diet  kitchen  experience.     This  method 
requires  a  great  deal  of  individual  instruction  and  supervision 
in  the  diet  kitchen,  and  there  is  danger  of  the  practical  and 
theoretical  side  of  the  work  not  being  so  closely  connected  up. 

ILLUSTRATIVE  MATERIAL  AND  EQUIPMENT 

1.  There  is  a  great  variety  of  illustrative  material  available 
in  the  form  of  food  charts,  sample  food  products,  models  of 
meat  cuts,  etc.     (See  list  of  firms,  Appendix  III). 

2.  A  full  equipped  cooking  laboratory  is  essential  for  the 
satisfactory  teaching  of  dietetics.     For  discussion  of  the  plan 
and  equipment  of  such  a  laboratory,   see  Teachers   College 
Record,  May,  1909. 

TEXT  AND  REFERENCE  BOOKS 

Friedenwald  and  Rurah:  Dietetics  for  Nurses. 

Pope  and  Carpenter:  Essentials  of  Dietetics. 

Pattee:  Practical  Dietetics. 

Hall :  Nutrition  and  Dietetics. 

McCollum:  The  Newer  Knowledge  of  Nutrition. 

Farmer:  Foods  and  Cookery  for  the  Sick  and  Convalescent. 

Farmer:  Boston  Cook  Book. 

Rose:  Handbook  of  Laboratory  Dietetics. 

Rose:  Feeding  the  Family. 

Barrows  and  Lincoln:  Home  Science  Cook  Book. 

Pamphlets  and  Bulletins:  Department  of  Agriculture. 

Cornell  and  Teachers  College  Bulletins. 


DIET   IN    DISEASE  57 


Diet  in  Disease 


TIME  10  hours  divided  as  follows: — Lectures  or  classes  given  by  a  physi- 
cian, nurse  or  dietitian — 5  hours.     Demonstrations  and  labora- 
tory work  conducted  by  trained  dietitian — 5  hours. 
Course  to  be  given  in  second  term  of  the  Preparatory  Year. 

OBJECTS  OP  COURSE 

To  apply  the  fundamental  principles  of  cookery  and  nutri- 
tion to  the  dietary  treatment  of  the  commoner  diseases.  In 
each  of  the  conditions  mentioned  below,  general  principles  of 
feeding  are  discussed,  diet  lists  examined,  menus  made  out, 
food  values  computed,  and  typical  diets  prepared  and  served. 
The  charting  of  diets  is  also  emphasized  and  the  importance 
of  proper  records,  especially  in  metabolism  studies.  Infant 
feeding  is  included  under  Diseases  of  Infants  and  Children 
P. 100. 

OUTLINE  or  CLASSES 

I.  Diet  in  diseases  of  the  digestive  system — gastritis,  constipation, 
diarrhoea,  dyspepsia,  gastric  ulcer,  dysentery,  acute  colitis, 
appendicitis,  gall-stones,  gastric  disorders.  Test  diets  and 
nutrient  enemata. 

II.  Diet  in  fevers — slight  infections,  tonsilitis,  pneumonia  and 
tuberculosis.  Special  typhoid  diets,  including  the  high  caloric 
feeding.  Diet  in  convalescence. 

III.  Diet  in  anaemia,  cardiac  disorders,  nervous  and  mental  condi- 
tions, obesity. 

IV.  Diet  in  nephritis,  cystitis,  calculus,  rheumatism,  gout,  scurvy, 
rickets  and  diabetes. 

V.  Diet  in  surgical  cases — for  control  of  nausea  in  peritonitis,  in 
laparotomies,  head  and  mouth  cases.  Formulae  used  for  feed- 
ing through  gastric  and  intestinal  fistulas  and  by  rectum. 

(Each  of  these  classes  should  be  followed  by  a  laboratory 
period  in  the  diet  kitchen  where  all  special  diets  would  be 
prepared.) 

METHODS  OF  TEACHING  AND  ILLUSTRATIVE  MATERIAL 

As  in  preceding,  course. 
TEXT  AND  REFERENCE  BOOKS 

Carter  and  Howe:  Nutrition  and  Clinical  Diet. 
Thompson:  Practical  Dietetics. 
Sherman:  Chemistry  of  Food  and  Nutrition. 
Friedenwald  and  Rurah:  Diet  in  Health  and  Disease. 
(See  also  under  Nutrition  and  Cookery) 


58  OUTLINES   OF  SUBJECTS 

Hospital  Housekeeping 

TIME:  10  hours.  Classes,  discussions,  demonstrations  and  written  re- 
ports. Conducted  by  the  instructor  of  nurses.  Given  in  the 
preparatory  course.  (Correlated  practice  work  outside  of  this 
time  to  be  given  in  nurses'  home  and  hospital  departments.) 

OBJECTS  OP  COURSE 

1.  To  give  the  student  a  better  understanding  of  the  prin- 
ciples and  methods  of  good  housekeeping  and  to  make  her  ap- 
preciate their  fundamental  importance  in  nursing  work. 

2.  To  enable  her  to  exercise  intelligence  and  economy  in  the 
proper  selection,  use  and  care  of  the  materials  and  equipment 
relating  to  her  work,  and  to  develop  a  high  degree  of  efficiency 
in  the  technic  and  organization  of  housekeeping  measures. 

OUTLINE   OF  CLASSES 

I.  Introduction 

Meaning  of  "Household  Economy."  The  nurses'  home  as  a 
type  of  larger  household.  General  plan.  Relation  of  one  de- 
partment to  another.  Principles  of  efficiency  and  economy  in 
the  household.  Visit  to  various  departments  of  the  nurses' 
home  and  talk  on  general  regulations  of  the  household.  Care 
of  nurses'  bed-room. 

II.  Cleaning  and  Polishing. 

Materials  to  be  cleaned — woods,  paints,  fabrics,  metals, 
glass,  rubber,  china,  etc.  Appliances  and  their  care — brooms, 
brushes,  mops,  etc.  Materials — soaps,  polishes,  bleaches,  etc. 
Methods  of  sweeping,  dusting,  cleaning,  scrubbing. 

Practice.  Daily  cleaning  of  bed-room  by  each  pupil.  Clean- 
ing of  silver,  brass,  marble,  etc. 

III.  Interior  Furnishings  and  Finishings. 

Materials  of  construction  of  floors — wood,  tile,  terrazzo, 
cement,  etc.  Dressings  and  coverings — paints,  oils,  polishes, 
linoleum,  rugs,  carpets,  etc.  Walls  and  ceilings — finish,  paints, 
paper,  tile,  etc. — materials  and  colors. 

Practice.    Thorough  house-cleaning  of  bed-room. 

IV.  Equipment  and  Arrangement 

The  kitchen,  pantry,  living  room,  dining  room,  etc.  Equip- 
ment of  each — use,  cost,  durability,  artistic  design,  sanitary 
aspect,  etc.  Arrangement  from  practical  and  artistic  stand- 
point. 

Practice.     Cleaning    and    arrangement   of   living  room   or 
library. 
V.  Healing  and  Ventilating  Systems 

Types  of  heating — radiation,  convection  (steam,  hot  water, 
hot  air).  Equipment — furnaces,  boilers,  ranges,  stoves,  grates, 


HOSPITAL  HOUSEKEEPING  59 

electrical  heaters.  Fuels — wood,  coal,  oil,  etc.  Use  of  meters. 
Ventilating  systems — natural  and  artificial  ventilation.  Tele- 
phone and  electric  bell  systems.  Fire  escapes  and  use  of  fire 
extinguishers.  Fire  drills. 

Practice.    Taking    room    temperature,    ventilating    rooms, 
practicing  fire  drill,  etc. 
VI.  Lighting  and  Plumbing  Systems 

Types  of  lighting — natural,  artificial,  direct,  indirect.  Equip- 
ment— fixtures,  lamps,  etc.  Cleaning  and  care.  Systems  of 
plumbing.  Water  supply  and  sewage  disposal — pipes,  traps, 
sink,  lavatory  equipment.  Their  cleaning  and  care. 

Practice.     Caring  for  lighting  and  plumbing  fixtures.    Clean- 
ing sinks,  bathrooms  and  lavatories  in  nurses'  home. 
VII.  Disposal  of  Garbage  and  Household  Pests 

Methods  of  garbage  disposal  and  hospital  wastes.  Special 
precautions  in  the  hospital .  Insects  found  in  food  and  clothing. 
Insects  injurious  or  disagreeable  to  people.  Means  of  extermi- 
nation. Protection  of  food  supplies  in  the  household. 

Practice.     Looking  over  garbage  cans  to  discover  sources  of 
waste.    Cleaning  of  kitchen  refrigerator,  care  of  food  supplies, 
etc. 
VIII.  The  Laundry 

Purpose  and  plan  of  the  laundry.  Care  of  soiled  linen. 
Gathering  linen — sorting,  washing,  bleaching,  rinsing,  man- 
gling. Soap  making.  Equipment — washers,  manglers,  extrac- 
tors, starch  kettle,  dryers,  etc.  Disinfection  of  linen.  Removal 
of  stains.  Washing  things  out  by  hand. 

Practice.    Pupil  should  spend  a  short  period  in  the  laundry, 
should  help  in  sorting  linen  and  see  all  the  processes  at  first 
hand. 
IX.  The  Central  Linen  Room,  Sewing  Room  and  Clothes  Room 

Purpose  and  plan  of  linen  room — arrangement,  inventory, 
mending,  marking,  folding.  Systems  of  replacement  and 
exchange.  Care  of  linen  closet  in  the  wards.  Care  of  patients' 
clothing — cleansing  and  repair — disinfection,  etc. 

Practice.    Looking  over  linen  for  mending,  folding  and  stack- 
ing linen,  caring  for  linen  closet,  etc. 
X.  Hospital  Supplies 

Economy  in  the  hospital.  Necessity  of  conserving  hospital 
finances  for  necessary  care  of  patients.  Cost  of  hospital  sup- 
plies. Sources  of  waste.  Methods  of  economy  in  standardiz- 
ing hospital  supplies  and  study  of  types  and  costs.  Visit  to 
store  room. 

Practice.  Making  out  lists  of  stores  with  costs — Making  up 
dressings  and  hospital  supplies  in  supply  room. 

METHODS  OF  TEACHING 

1.  To  make  the  course  comprehensive  the  objects  should  as 
far  as  possible,  be  placed  before  the  students  and  attention 


60  OUTLINES   OF  SUBJECTS 

directed  to  points  under  discussion.  Where  this  is  not  possible 
cuts  from  catalogs  may  be  used.  Catalogs  may  be  also  used 
to  get  prices  of  hospital  supplies.  Pupils  should  themselves 
look  these  up  and  bring  to  class. 

2.  When  possible  the  instructor  should  illustrate  by  demon- 
strating or  by  taking  pupils  to  the  various  departments  and 
showing  them  processes  in  operation.     All  students  should  have 
an  opportunity  to  carry  out  the  practical  procedures  as  soon  as 
possible  after  the  lesson. 

3.  This  instruction  should  be  closely  correlated  with  that  of 
chemistry,  physics,  bacteriology,  hygiene,  and  sanitation.     It 
should,  if  possible,  precede  the  course  in  practical  nursing,  and 
might  be  given  in  daily  classes  during  the  first  ten  days  as  a 
preparation  for  later  work  in  the  hospital. 

4.  Pupils  may  be  assigned  full  care  of  their  own  rooms  during 
the  preparatory  course.     Practice  should  also  be  provided  in  the 
nurses'  home,  laundry,  diet  kitchen,  supply  room  and  other 
departments  of  the  hospital  where  the  above  principles  can  be 
applied.    The  time  spent  in  such  work  should  be  limited  as  it 
is  important  only  that  pupils  should  get  a  good  command  of 
fundamental  processes  and  not  that  they  should  be  employed 
in  routine  household  work. 

EQUIPMENT  AND  ILLUSTRATIVE  MATERIAL 

Individual  utensils  and  tools  for  work  as  far  as  possible. 
Samples  of  flooring  materials,  cleaning  agents,  etc.  Catalogs. 
Illustrations  from  current  magazines. 

TEXT  AND  REFERENCE  BOOKS 

Parloa:  Home  Economics. 

Richards:  Home  Sanitation. 

Broadhurst:  Home  and  Community  Hygiene. 

Campbell:  Household  Economics. 

Terrill:  Household  Management. 

Balderston:  Laundry  Manual. 

Balderston:  Housewifery. 

Kinne  and  Cooley:  Shelter  and  Clothing. 

Putnam:  Plumbing  and  Household  Sanitation. 

Butler:  Household  Physics. 

Lynde:  Physics  of  the  Household. 

Priestman:  Art  and  Economy  in  Home  Decoration. 

Kittredgc:  Practical  Home  Making. 

U.  S.  Government  Bulletins  1914— No.  37,  38,  and  39. 

Housekeeping  Problems  of  Industrial  Families  ((Elective) 

TIME:  10  hours.     Classes,   demonstrations,   and  excursions.    Given  by 
a  visiting  nurse  or  a  visiting  housekeeper,  with  the  possible 


HOUSEKEEPING   PROBLEMS  OF  INDUSTRIAL  FAMILIES  61 

assistance  of  the  hospital  dietitian.    To  be  given  in  the  latter 
part  of  the  third  year. 

OBJECTS  OF  THE  COURSE 

This  course  is  intended  for  pupils  who  expect  to  go  into 
families  either  as  private  or  public  health  nurses.  It  is  de- 
signed to  help  them  to  understand  the  economic  problems  of  the 
family  of  limited  income,  and  to  enable  them  to  give  assistance 
and  advice  in  matters  pertaining  to  the  proper  feeding  and 
care  of  the  household. 

OUTLINE  OF  CLASSES 

I.  The  Household  Budget 

The  varying  costs  of  living  as  indicated  by  budget  studies. 
The  value  of  a  budget  in  helping  towards  a  wiser  planning  of 
expenditures,  and  a  more  thrifty  use  of  the  income.  Methods 
and  standards  to  be  followed  in  estimating  a  budget  for  a 
family. 

Assigned  work.    Planning  a  weekly  budget  for  a  family  of  a 
certain  size  and  income. 
II.  Housing  Standards  and  Costs 

The  importance  of  good  housing.  Characteristics  of  a  satis- 
factory house  from  the  health  standpoint.  Proportion  of 
income  ideally  to  be  used  for  rent.  Rents  which  are  charged 
in  the  vicinity  in  relation  to  wages  being  paid. 

III.  Food  Costs 

Variations  in  the  cost  of  food  per  person,  as  indicated  by 
"cost  of  living"  studies.  Minimum  standards  for  food  expendi- 
tures. Characteristics  and  limitations  of  a  low  cost  dietary. 
Assigned  work :  Planning  very  inexpensive  meals  for  a  family 
for  a  day,  reckoning  food  value  and  cost. 

IV.  Food  Selection  and  Care. 

Importance  of  buying  clean  food  in  a  clean  store,  and  caring 
properly  for  it  in  the  home.    Points  to  be  considered  in  select- 
ing inexpensive  meat,  fish,  fruits,  vegetables,  cereal  products, 
etc.     (Trip  to  market  or  food  store  if  at  all  possible.) 
V.  Reducing\Food  Costs 

Value  of  planning  meals  ahead;  buying  in  person  for  cash,  in 
as  large  quantities  as  practicable ;  cooking  food  when  possible 
rather  than  using  prepared  products;  choosing  food  which  will 
give  largest  nutritive  return  for  the  money;  keeping  household 
accounts.  Using  fireless  cooker,  iceless  refrigerator,  and  other 
appliances  which  make  possible  low  cost  cooking  and  low  cost 
caring  for  food. 

VI.  Racial  habits  and  customs,  climate,  and  other  factors  which  influ- 
ence dietary  selection  (with  special  reference  to  the  feeding 
of  children.) 


62  OUTLINES   OF  SUBJECTS 

Characteristics  of  Italian,  Russian,  Jewish,  Polish,  Irish, 
German  and  Negro  dietaries.  Changes  to  be  advised  if  found 
inadequate  under  local  conditions.  The  dietary  in  the  rural 
and  urban  community;  winter  and  summer  dietaries  as  illustra- 
tive of  the  dietary  of  cooler  and  warmer  climates.  Food 
requirements  at  different  ages. 
VII.  Special  Diets  in  (he  Home 

Planning  the  home  diet  of  tubercular  and  diabetic  patients, 
expectant  mothers  and  others  requiring  marked  variation  of 
the  ordinary  family  dietary. 
VIII.  Clothing  Standards  and  Costs 

Hygienic  essentials  in  clothing  for  men,  women  and  children. 
Minimum  costs  for  clothing.     Economics  in  the  purchasing  of 
clothing  which  might  be  practised. 
IX.  Laundering  and  Housekeeping  Methods 

The  importance  of  cleanliness  in  the  home.     Relative  values 
in  laundering  and  cleaning  supplies.    Labor  saving  devices 
and  methods. 
X.  Household  Management  and  Thrift. 

The  importance  of  system  in  household  management,  especi- 
ally as  it  affects  the  care  of  children  or  a  sick  person.  Methods 
of  planning  and  organizing  household  tasks.  The  importance 
of  thrift  which  will  make  possible  the  saving  towards  sickness 
or  other  household  emergency. 

METHOD  OF  TEACHING 

1.  The  most  satisfactory  way  is  to  have  the  pupil  study 
individual  families  with  the  object  of  assisting  them  in  working 
out  a  satisfactory  budget  on  an  economic  basis.     Such  work 
might  be  done  through  the  social  service  department,  a  visiting 
nurse  association,  or  a  charity  organization  society. 

2.  Individual  or  class  visits  to  tenements  stores  and  markets 
in  various  parts  of  the  city  are  also  exceedingly  helpful  in  get- 
ting a  clear  picture  of  sanitary  conditions  and  the  housing  and 
shopping  problems  of  the  family. 

3.  Plenty  of  outside   practice   in   making   out  menus   and 
dietaries  for  typical  cases  should  be  provided. 

ILLUSTRATIVE  MATERIAL  AND  EQUIPMENT  (see  Cooking  and  Dietetics) 

Local  dealers'  catalogs  and  market  guides  can  also  be  used 
to  good  advantage. 

TEXT  AND  REFERENCE  BOOKS 

Streightoff :  Standard  of  Living. 
Chapin:  Standard  of  Living  in  New  York  City. 
Nearing:  Financing  the  Wage  Earner's  Family. 
Gibba:  Lessons  in  Feeding  the  Family. 


HOUSEKEEPING  PROBLEMS  OF  INDUSTRIAL  FAMILIES  63 

Nesbitt:  Low  Cost  Cooking. 

Jaffa:  A  Standard  Dietary  for  an  Orphanage. 

Rose:  Food  for  School  Boys  and  Girls. 

Rose:  Feeding  the  Family. 

Langworthy:  Food   Customs   and   Diet   in   American  Homes. 

U.  S.  Dept.  Ag.,  Bulletin  110. 
Hills  and  others:  Dietary  Studies  in  Rural  Regions.    U.  S. 

Dept.  of  Agriculture,  Bulletin  221. 

Rose:  Cost  of  Food.     Cornell  Bulletin,  Food  Series  No.  7. 
American  Home  Economics  Association :  Thrift  by  Household 

Accounting. 


C.  PREVENTION  OF  DISEASE 

Personal  Hygiene 

TIME:  10  hours.  Classes  conducted  by  the  instructor  of  nurses.  Given  in 
the  early  part  of  the  preparatory  course.  (Supplemented  by  a 
course  of  physical  exercises  in  a  gymnasium  if  at  all  possible — 
otherwise  the  simple  exercises  given  in  Appendix  IV  might 
be  taught  by  the  instructor  in  connection  with  the  hygiene 
classes. 

OBJECTS  OF  COURSE 

1.  To  impress  upon  the  pupil  nurse  the  paramount  importance 
of  good  health,  and  to  help  her  to  protect  herself  and  keep  her- 
self well  through  understanding  and  practising  the  fundamental 
laws  of  health. 

2.  To  show  the  close  relationship  of  hygiene  to  all  nursing 
work,  to  emphasize  the  teaching  function  of  the  nurse,  especially 
in  matters  relating  to  hygiene,  and  to  develop  a  rational  and 
scientific  attitude  toward  the  whole  question  of  health  pres- 
ervation and  disease  prevention. 

3.  To  teach  a  few  general  exercises   which  will    help    to 
strengthen  special  muscles  and  keep  the  whole  body  in  good 
condition.    To  establish  habits  of  regular  outdoor  exercise. 

OUTLINE  OP  CLASSES 

I.  Introduction 

Health  and  disease  defined.  Ancient  and  modern  theories 
about  disease.  Causes  classified.  Definitions  of  hygiene, 
sanitation,  public  health,  etc.  Various  ideals  and  conceptions 
of  health.  Conditions  governing  individual  health.  Ethical 
and  economic  aspects  of  hygiene.  Importance  of  hygiene  to 
the  nurse.  Her  educational  function  as  an  example  and  teacher 
of  hygiene. 
II.  Hygiene  of  Exercise 

Muscular  activity  in  relation  to  health.  Kinds  of  exercise 
and  adaptation  to  age,  sex,  occupation,  climate,  etc.  Meaning 
of  recreation.  Value  of  sports  and  games.  Fatigue,  its  symp- 
toms and  effects.  Methods  of  rest  and  relaxation,  mental  and 
physical.  Importance  of  posture  and  right  methods  of  stand- 
ing, bending  and  walking. 
III.  Hygiene  of  the  Skin 

Structure  and  functions  of  the  skin.  Bathing.  Kinds  of 
baths  and  effects  of  different  temperatures.  Care  of  the  teeth, 
hair,  nails  and  hands.  Soaps  and  toilet  accessories — their 
use  and  abuse.  Prevention  and  treatment  of  common  skin 
infections  and  minor  injuries. 
64 


PERSONAL  HYGIENE  65 

IV.  Hygiene  of  Clothing 

Function  of  clothing.  Materials — cotton,  silk,  wool,  linen, 
etc.,  and  their  various  uses.  Adaptation  of  clothing  to  cli- 
mate, age,  occupation,  etc.  Hygienic  clothing  for  the  nurse 
on  and  off  duty.  How  to  choose  a  good  shoe.  Special  care  of 
the  feet.  Prevention  and  treatment  of  corns,  bunions,  ingrow- 
ing toe-nails,  and  other  foot  troubles.  Care  of  arch  of  foot. 
Preventive  exercises. 
V.  Hygiene  of  Respiration 

Composition  of  normal  air.  Sources  of  impurities  in  the  air. 
Effect  of  temperature  and  moisture,  still  and  moving  air. 
Principles  of  ventilation.  Types  of  breathing.  The  use  of  the 
voice — tone,  pitch,  quality,  etc.  Some  principles  of  correct 
speech  and  breathing. 
VI.  Hygiene  of  Nutrition, 

Relation  of  food  and  food  habits  to  efficiency.  Energy  re- 
quirement of  average  nurse  on  active  duty.  Food  fads,  over- 
eating, and  under-eating.  Conditions  which  interfere  with 
digestion  and  nutrition.  Use  of  condiments,  stimulants  and 
drugs.  Water-drinking.  Hygiene  of  elimination.  Constipa- 
tion— common  causes  and  measures  for  relief. 
VII.  Hygiene  of  Special  Senses 

The  causes  and  effects  of  common  eye  troubles.  Conditions 
for  normal  vision.  Care  and  protection  of  the  eyes  especially 
in  hospital  work.  Need  of  expert  examination  and  treatment 
in  eye  defects.  Common  disorders  of  hearing — their  causes 
and  effects.  Protection  and  care  of  the  ear.  Causes  and  symp- 
toms of  common  nose  and  throat  troubles.  Prevention  and 
care  of  colds  and  sore  throats. 
VIII.  Hygiene  of  the  Nervous  System 

Importance  of  nervous  system  to  health  of  the  whole  body. 
Ways  in  which  mental  influences  affect  the  body.  Conditions 
in  modern  life  which  produce  high  nervous  tension  and  fatigue. 
Increase  of  nervous  diseases  and  insanity.  Importance  of  re- 
laxation and  sleep  for  conservation  of  nervous  energy.  Some 
principles  of  mental  hygiene  for  both  nurse  and  patient. 
IX.  Hygiene  of  the  Reproductive  System 

Function  of  menstruation  and  common  disorders.  Precau- 
tions and  ordinary  measures  to  be  observed.  Problems  of 
social  hygiene  which  confront  the  nurse.  Necessity  for  a  sane 
and  wholesome  attitude  of  mind . .  Effects  of  ignorance  and 
wrong  teaching  in  the  community  at  large.  Ways  in  which 
the  nurse  can  help  to  promote  racial  and  personal  health  and 
happiness.  Essentials  of  sex-hygiene. 
X.  Relation  of  Personal  Hygiene  to  Community  Health 

Outstanding  causes  of  ill-health  in  the  community  due  largely 
to  individual  ignorance  and  neglect.  Standards  of  community 
health  as  shown  in  death-rates.  What  constitutes  a  high  and 


66  OUTLINES   OF   SUBJECTS 

low  mortality  rate  for  the  general  population — for  infants. 
Main  causes  of  premature  death  and  illness.  Some  movements 
for  the  conservation  of  individual  and  public  health  by  volun- 
tary organization  for  prevention  and  care  of  tuberculosis,  can- 
cer, social  diseases,  diseases  of  infancy,  diseases  of  middle  age, 
insanity,  etc.  How  the  nurse  in  the  hospital  and  home  may 
help  to  educate  the  public. 

METHODS  OF  TEACHING 

1.  Base  hygienic  rules  on  scientific  principles,  using  courses 
in  anatomy  and  physiology  and  bacteriology  as  ground-work. 

2.  Stress  the  phases  of  the  subject  most  needed  by  nurses, 
and  emphasize  applications  to  nursing  work. 

3.  Knowledge  of  hygiene  is  not  of  much  use  unless  it  is  con- 
sistently applied.     Effort  must  be  made  to  arouse  stong  in- 
centives as  a  means  of  forming  good  hygienic  habits.     Some 
teachers  have  pupils  keep  daily  records  for  a  time  of  baths, 
exercise,  sleep,  etc.,   and  report  progress  in  habit-formation. 
Often  illness  and  slight  indispositions,  such  as  colds,  etc.,  can 
be  traced  back  to  personal  lapses,  and  sentiment  formed  in 
the  school  will  aid  greatly  in  maintaining  good  standards  of 
health. 

4.  Text  books  if  used  at  all  should  be  liberally  supplemented 
by  outside  readings  from  a  variety  of  reference  books,  pam- 
phlets, etc.    Pupils  in  this  way  get  a  wider  range  of  information 
and  a  better  knowledge  of  sources.    They  should  be  encouraged 
to  collect  interesting  cuttings  from  magazines,  pamphlets,  etc., 
and  report  on  these  in  class. 

EQUIPMENT  AND  ILLUSTRATIVE  MATERIAL 

Anatomical  charts,  skeleton,  models,  etc.  Popular  litera- 
ture, posters,  exhibit  material.  Lantern  and  slides.  Gymna- 
sium or  room  fitted  up  with  simple  apparatus,  a  distinct  asset. 
Also  swimming  pool. 

TEXT  AND  REFERENCE  BOOKS 

Price:  Hygiene  and  Sanitation  for  Nurses. 

Hough  and  Scdgwick:  Human  Mechanism  (Part  II). 

Pyle:  Personal  Hygiene. 

Galbraith:  Hygiene  and  Physical  Culture  for  Women. 

Latimer:  Girl  and  Woman. 

CFouston:  Hygiene  of  the  Mind. 

Rosenau:  Preventive  Medicine. 

Chapin:  Sources  and  Modes  of  Infection. 

Fisher  and  Fi.ske:  How  to  Live. 

Lee:  Health  and  Disease. 

Bancroft:  Posture  of  School  Children. 


PUBLIC  SANITATION  67 

Lovett:  Lateral  Curvature  of  the  Spine  and  Round  Shoulders. 

McKenzie:  Exercise  in  Education  and  Medicine. 

Pamphlets  published  by  organizations  dealing  with  prevention 

of  disease  (see  Appendix  II.) 
For  Household  Hygiene  see  under  Hospital  Housekeeping. 

Public  Sanitation 

TIME:  10  hours.  Lectures  and  quizzes  conducted  by  physician  with 
Board  of  Health  experience,  or  sanitarian,  if  possible. — Given 
in  senior  year. 

OBJECTS  OP  COURSE 

1.  To  give  the  nurse  a  general,  practical  knowledge  of  the 
methods  which  are  being  used  to  protect  the  health  of  individ- 
uals and  communities  so  she  may  cooperate  actively  with  Boards 
of  Health  and  other  preventive  agencies,  and  be  able  to  take 
a  definite  share  in  educating  the  public  in  matters  relating  to 
public  health. 

OUTLINE  OP  LECTURES 

I.  Introduction 

History  of  sanitation,  and  older  theories  regarding  the  causes 
of  disease.  Modern  ideas  as  to  sources  and  modes  of  infection. 
Parasites  and  hosts.  R6le  of  carriers,  air,  dust,  discharges, 
fomites,  contact,  food  and  drink,  insects.  Portals  of  entry  and 
exit  in  all  commoner  infections.  Communicable  diseases  clas- 
sified according  to  source  of  infection. 
II.  Sewage  and  Garbage  Disposal 

Danger  from  excreta.  Composition  of  sewage.  Methods  of 
disposal  in  large,  small  and  rural  communities.  Dangers  from 
garbage.  Composition  and  methods  of  disposal. 

III.  Water  Supply  and  Ice 

Sources  of  water  supply.  Dangers  of  polluted  water — pro- 
tection of  water  supply.  Purification  processes.  Special  prob- 
lems of  rural  communities.  Use  of  household  filters.  Sources 
of  ice  supply.  Dangers  and  methods  of  protection. 

IV.  Food  Supply 

Dangers  of  unclean  or  infected  food  supplies,  especially  meat, 
shellfish,  uncooked  fruits  and  vegetables.  Protection  of  food 
supplies  from  dust  and  flies,  from  adulteration  and  misbrand- 
ing.  Pure  food  legislation.  Special  dangers  from  milk — ani- 
mal diseases  and  human  infection.  Production  of  clean  milk. 
Dairy  inspection.  Bacteriological  tests.  Inspection  of  res- 
taurants and  lunch-counters.  Medical  examination  of  cooks, 
waiters  and  others  who  handle  food. 
V.  Air  Supply  and  Ventilation 

Normal  air  and  its  pollutions.  Main  dangers — excessive 
heat  with  excessive  humidity.  Methods  of  air  analysis.  Effects 


68  OUTLINES   OF   SUBJECTS 

of   dry   air.    Ventilation   standards.     Natural    and    artificial 
methods  of  ^'entilation.    Dangers  in  dust,  largely  mechanical. 
Relation  to  tuberculosis.    Methods  of  reducing  dust  in  indus- 
trial establishments. 
VI.  Housing  and  Extermination  of  Vermin 

Effects  of  over-crowding.  The  tenement  house  problem. 
Relation  to  tuberculosis,  social  diseases,  and  infant  mortality. 
Fundamental  needs — fire  protection,  light,  air,  and  cleanliness. 
Remedial  and  preventive  measures.  Essentials  of  sanitary 
inspection.  Insects  as  carriers  of  disease.  Household  and 
community  measures  for  controlling  vermin  pests,  flies,  mos- 
quitoes, etc. 
VII.  Industrial  Hygiene 

Brief  history.  Dangers  of  industry.  Preventable  accidents 
on  railroads,  in  mines  and  factories.  Prevention  of  industrial 
poisoning.  Dangerous  trades.  Over-work  and  fatigue.  Re- 
medial agencies.  Education,  legislation,  and  inspection. 
Work  of  Consumers  League  and  other  agencies.  Welfare  work 
in  factories  from  sanitary  point  of  view. 
VIII.  Hygiene  of  Schools,  Public  Buildings  and  Conveyances 

Importance  of  school  hygiene  in  relation  to  community 
health.  Essentials  of  school  hygiene  as  to  construction,  venti- 
lation, light,  seats,  cleanliness,  water-supply,  toilet  facilities, 
fire  protection,  etc.  Medical'inspection  and  school  nursing  in 
relation  to  control  of  contagious  diseases  and  identification 
of  physical  defects.  Hygiene  of  other  public  buildings  such  as 
churches  and  theatres,  of  street  cars  and  railways  coaches  (es- 
pecially sleeping  cars).  Public  toilets  in  relation  to  health. 
IX.  Vital  Statistics. 

Place  of  vital  statistics  in  public  health  work.  Neglect  of 
vital  statistics  in  United  States.  Laws  for  registration  of  births 
and  deaths.  Important  points  in  the  compilation  and  analysis 
of  statistics.  Interpretation  of  statistical  data.  High  and 
low  death  rates  for  adults  and  infants.  Mortality  from  im- 
portant classes  of  disease  compared. 
X.  Health  Departments  and  Health  Legislation 

National,  state,  and  local  Boards  of  Health — province,  powers 
and  organization  of  each.  Function  of  bureaus  of  sanitation, 
contagious  diseases,  laboratory  service,  vital  statistics;  pub- 
licity, etc.  General  progress  of  health  legislation.  Rural 
health  organization.  Publications  of  health  departments. 

METHODS  OF  TEACHING 

1.  The   classes  will   usually   be   conducted  by   the   lecture 
method,  supplemented  by  quizzes  if  possible. 

2.  Base  the  present  course  on  previous  knowledge  of  chem- 
istry, bacteriology,  and  hygiene,  and  correlate  closely  with  the 
course  in  comrnunioablo  diseases. 


PUBLIC    SANITATION  69 

3.  If  possible,  visits  should  be  made  to  a  sewage  disposal 
plant,  a  model  dairy,  an  industrial  plant,  and  other  local  places 
of  interest,  to  get  a  clear  and  vivid  conception  of  conditions 
and  methods.  Otherwise  photographs,  diagrams,  and  models 
could  be  shown.  Several  good  moving-picture  screens  on  sani- 
tary subjects  are  in  circulation  and  should  be  seen.  Excellent 
exhibits  are  on  view  in  the  Natural  History  Museum  in  New 
York  City  and  in  similar  institutions  in  other  cities.  The 
National  Public  Health  Service  and  several  state  and  local 
Health  Boards  have  loan  collections  of  lantern  sides  which 
can  be  borrowed  for  a  time  for  educational  work. 

EQUIPMENT  AND  ILLUSTRATIVE  MATERIAL 

Lantern  slides,  models,  charts,  maps,  etc.  A  collection  of 
pamphlets  and  reports  from  Boards  of  Health  and  voluntary 
orgznizations  are  very  helpful  and  can  be  secured  free  of  cost. 
(See  lists  Appendix  II  and  III.) 

TEXT  AND  REFERENCE  BOOKS 

Price:  Hygiene  for  Nurses. 

Rosenau:  Preventive  Medicine  and  Hygiene. 

Baskerville:  Municipal  Chemistry. 

Chapin:  Sources  and  Modes  of  Infection. 

Kinnicutt  and  Winslow:  Sewage  Disposal. 

Kober:  Industrial  and  Personal  Hygiene. 

Oliver:  Diseases  of  Occupation. 

Sedgwick:  Principles  of  Sanitary  Science  and  Public  Health. 

Doane:  Insects  and  Disease. 

Hill:  The  New  Public  Health. 

Broadhurst:  Home  and  Community  Hygiene. 

Veiller:  Housing  Reforms. 

American  Journal  of  Public  Health. 

Local  and  State  Board  of  Health  Bulletins. 

Public  Health  Service  Bulletins. 

See  also  under  Bacteriology,  Hygiene,  and  Communicable 
Diseases. 


D.  TREATMENT  OF  DISEASE 

Drugs  and  Solutions 

TIME:  20  hours  or  ten  two-hour  periods  divided  about  equally  between 
class  and  laboratory  work.     Teacher — the  instructor  of  nurses 
(preferably)  or  the  pharmacist. 
To  be  given  in  the  Preliminary  Course. 

OBJECTS  OF  THE  COURSE 

1.  To  make  the  nurse  familiar  with  the  appearance  and  use 
of  the  commoner  drugs  which  she  will  be  handling  in  the  earlier 
part  of  her  course. 

2.  To  teach  her  to  weigh  and  measure  drugs  accurately,  to 
make  up  all  the  standard  solutions,  and  the  commoner  phar- 
maceutical preparations  used  in  the  wards. . 

3.  To  teach  her  the  terms  and  symbols  used  in  materia  medica 
and  prepare  her  for  the  further  study  of  the  therapeutic  action 
of  drugs. 

OUTLINE  OF  CLASSES  AXD  LABORATORY  WORK 

I.   (Class)  Introduction — Weights,  Measures,  Symbols,  etc. 

Review  of  simple  arithmetical  problems.  Roman  and  arabic 
numerals.  English  system  of  weights  and  measures.  Symbols, 
abbreviations.  Drops  and  minims. 

(Laboratory)  Practice  in  use  of  apothecaries'  weights  and 
measures.     Drill  in  the  tables.     Problems,  oral  and  written. 
II.   (Class)  Weights  and  Measures  (continued) 

Metric  system.  Approximates  in  apothecaries  and  house- 
hold measures. 

(Laboratory)     Practice  in  use  of  metric  system.     Drill  and 
problems  in  approximates. 
III.  (Class)     Solutions. 

Definition  of  solute,  solvent,  and  examples.  Saturated  and 
supersaturated  solutions.  Solutions  of  solids,  liquids  and 
gases  (examples).  Fahrenheit  and  Centigrade  scales.  Method 
of  expressing  strength,  ratio  and  percentage.  Method  of 
calculating  solutions  from  pure  drug. 

(Laboratory)     Make  physiological  salt   solution.     Problems 
and  drill  in  converting  ratio  to  per  cent  and  vice  versa.     Prob- 
lems in  calculating  the  amount  of  drug  for  solutions  of  different 
strength. 
IV  and  V.   (Class)     Disinfectants,  Antiseptic,  Deodorants 

Physical  properties,  therapeutic  uses,  method  of  bactericidal 
action,  care  in  handling,  and  toxicology  of  common  solutions, 
such  as  phenol,  bichloride,  boric,  iodine,  crcolin,  lysol,  formalin. 

(Laboratory)  Practice  in  making  these  solutions.  Problems 
and  drill  in  calculations. 

70 


DRUGS  AND   SOLUTIONS  71 

VI.  (Class)     Symbols  and  Abbreviations 

Orders  and  abbreviations  used  in  order  book.  Prescriptions, 
form,  abbreviations.  Method  of  making  weak  from  strong 
solutions. 

(Laboratory)     Practice    in    making    solutions    from    stock. 
Problems  in  calculations .    Practice  in  reading  prescriptions. 
VII.  (Class)    Dosage 

Method  of  calculating  doses  for  children.  Method  of  cal- 
culating fractional  doses.  Method  of  measuring  minims  and 
half  drop. 

(Laboratory)    Review  of  solutions.    Practice  in  measuring 
fractional  doses  and  in  calculating  children's  doses. 
VIII.  (Class)     Common  Pharmaceutical  Preparations 

Sources  of  drugs.  Crude  drugs,  Methods  of  preparing 
tinctures,  extracts,  emulsions,  etc.  Method  of  application  of 
local  remedies  such  as  ointments,  salves,  liniments,  supposi- 
tories. 

(Laboratory)    Visit    to    pharmacy.    Some  of  preparations 
made  by  students  or  demonstrated. 
IX.  (2-hour  class  and  quiz)     Action  of  Drugs  on  the  Body 

Meaning  of  terms  such  as  local,  systemic,  cumulative,  ra- 
tional, empiric,  physiological  and  therapeutic,  with  examples. 
Methods  of  administration,  absorption  and  excretion  of  drugs. 
Forms  suitable  for  each  method  of  administration.  Names  and 
meanings  of  common  classes  of  drugs  such  as  analgesics,  ano- 
dynes, diuretics,  and  common  examples. 

X.  (2-hour  class  and  quiz)     Introduction  to  a  Few  Specially  Im- 
portant Drugs 

Common  potent  drugs' — strychnine,  caffeine,  atropine,  and 
morphine.  Use,  forms  commonly  used,  early  symptoms  of 
over-dosage,  treatment  of  poisoning.  Common  cathartics, 
emetics  and  carminatives.  Action  and  method  of  administra- 
tion. Dangers  in  the  use  of  habit-forming  drugs.  The  patent 
medicine  evil,  and  the  menace  of  self-drugging.  Use  and  abuse 
of  drugs. 

METHODS  OF  TEACHING 

1.  Class  periods  should  be  conducted  by  the  question  and 
answer  method,  with  full  discussion  of  all  the  new  drugs  which 
have  come  under  the  pupil's  observation. 

2.  Laboratory  periods  should  be  held  in  a  specially  fitted 
up  class-room  or  in  the  hospital  pharmacy.     Pupils  should 
make  up  solutions  and  should  have  extra  experience  in  the 
pharmacy,  if  possible,  in  the  making  up  of  stock  preparations 
of  various  kinds. 

3.  A  great  deal  of  drill  will  be  needed  in  the  making-up  of 
solutions  and  solving  of  solution  problems.     Many  of  these 
arithmetical  problems  may  be  worked  out  outside  of  class  and 


72  OUTLINES   OF   SUBJECTS 

handed  in.  Many  teachers  find  it  necessary  to  give  a  pre- 
liminary drill  of  two  or  three  lessons  in  fractions,  decimals, 
proportion  and  percentage. 

EQUIPMENT  AND  ILLUSTRATIVE  MATERIAL 

Drugs  in  different  forms.  Samples  of  crude  drugs  and  grow- 
ing plants  when  possible.  Charts  for  metric  and  English  system 
and  all  the  different  kinds  of  measures' — pitchers,  measures, 
funnels,  etc.  (a  set  for  each  pupil  in  the  laboratory  section)  and 
stock  bottles  of  all  the  common  drugs  for  making  up  solutions. 

TEXT  AND  REFERENCE  BOOKS 

Dock:  Materia  Medica  for  Nurses. 

Parker:  Materia  Medica. 

Stimson:  Nurses'  Handbook  of  Drugs  and  Solutions. 

Bastedo:  Materia  Medica  and  Therapeutics. 

Sollmann:  Text  Book  of  Pharmacology. 

New  and  Non-Official  Drugs — (published  yearly  by  the  Ameri- 
can Medical  Association). 

Stevens:  Modern  Materia  Medica  and  Therapeutics. 

Blumgarten:  Materia  Medica  for  Nurses. 

Foote:  Essentials  of  Materia  Medica  and  Therapeutics  for 
Nurses 

Materia  Medica  and  Therapeutics 

TIME:  20  one-hour  periods.     To  be  given  in  the  second  half  of  the  first 
year,  preferably  by  a  physician. 

OBJECTS  OF  COURSE 

1.  To  continue  the  study  of  drugs  from  the  standpoint  of 
their  therapeutic  action,  emphasizing  the  accurate  and  intelli- 
gent administration  of  medicines,   and  the   observation  and 
reporting  of  results. 

2.  To  teach  pupil  nurses  enough  about  the  nature  and  thera- 
peutic action  of  drugs,  so  that  they  may  understand  the  general 
purposes  for  which  different  drugs  are  ordered,  may  cooperate 
intelligently  with  the  physician  in  his  effort  to  get  the  best 
results  from  the  drug,  and  may  appreciate  the  importance  of 
observing    the    after-effects,    particularly   watching    for    any 
dangerous  or  untoward  effects  from  drugs. 

3.  They  should  also  be  familiar  with  the  toxic  doses  of  all  the 
more  dangerous  drugs,  so  that  they  may  better  safeguard  the 
patients  from  possible  errors.     Every  nurse  should  know  the 
antidotes  for  all  common  forms  of  poisoning  and  should  be 
ready  to  render  first  aid  in  such  cases. 

OUTLINE  OF  CLASSES 

I.  Applications  of  Chemistry  to  Materia  Medica.     Active  princi- 
ples of  plants — alkaloids,  glucosides,  oils,  etc.     Chemical  and 


MATEKIA  MEDICA  AND  THERAPEUTICS  73 

physical  properties,  therapeutic  action  and  use,  source  and 
examples.    Action  and  common  uses  of  acids,   alkalies  and 
medicinal  salts. 
II.  Poisons  and  Antidotes 

Studied  in  groups — acids,  metallic  salts,  alkaloids,  etc.,  with 
general  principles  for  the  treatment  of  poisoning  by  each  type. 
Demonstration  or  practice  in  preparation  of  general  antidotes. 
Ill,  IV,  V,  VI.  Drugs  which  Act  on  the  Nervous  System 

Central  stimulants.    Central  depressants.   Hypnotics.    Gen- 
eral anesthetics.     Local  anesthetics.    Analgesics.    Anodynes. 
Mydriatics.    Myotics. 
VII,  VIII,  IX.  Drugs  which  Act  on  the  Circulatory  System 

Tonics.     Stimulants.     Depressants.     Vasodilators.     Vaso- 
constrictors.   Hematinics. 
X,  XI.  Drugs  which  Act  on  the  Respiratory  System 

Stimulants.    Sedatives.    Antiseptics.    Expectorants. 
XII.  Drugs  which  Act  on  the  Digestive  System 

Emetics.   Antiemetics.    Digestants.    Stomachics.    Intestinal 
Antiseptics.       Carminatives.       Cathartics.       Antidiarrheics. 
Anthelmintics. 
XIV,  XV.  Drugs  which  Act  on  the  Excretory  System. 

Diaphoretics.    Anhidrotics.    Urinary  antiseptics.    Diuretics. 
XVI,  XVII.  Drugs  which  Act  on  Skin  and  Mucous  Membranes 

Counter-irritants.    Disinfectants.    Astringents.    Styptics. 
XVIII,  XIX.  XX.  Specifics  and  Miscellaneous  Drugs 

Phosphorus.     Iodides.     Antipyretics.     Specifics.     Quinine. 
Mercury.    Salvarsan.    Salicylates. 


1.  Same  general  principles  as  outlined  under  Drugs  and 
Solutions. 

2.  Every  opportunity  should  be  taken  to  tie  up  the  class  work 
with  the  ward  work.    Pupils  should  be  asked  to  report  on  the 
action  of  drugs  being  used  on  their  wards.    The  teacher  should 
visit  the  wards  and  quiz  the  pupils  on  the  medicines  which  are 
being   given   to  different  patients  and  the  effects  they  have 
observed.    Any  unusual  action  of  drugs,  such  as  a  drug  rash, 
or  any  case  where  a  rare  or  new  drug  is  being  used,  should  be 
brought  to  the  attention  of  the  whole  class  in  the  form  of  a 
clinic. 

3.  Frequent  short  tests,  both  oral  and  written,  should  be 
given.    The  analysis  of  prescriptions  to  determine  the  amount 
of  any  given  drug  being  given  in  one  dose  or  in  24  hours,  is 
often  helpful. 

EQUIPMENT  AND  ILLUSTRATIVE  MATERIAL 

Same  as  under  Drugs  and  Solutions — also  bedside  charts. 


74  OUTLINES    OF   SUBJECTS 

TEXT  AND  REFERENCE  BOOKS 

See  under  Drugs  and  Solutions. — Also 

Hare:  Practical  Therapeutics. 

Brunton:  Lectures  on  the  Action  of  Medicines. 

Stainsbury:  Drugs  and  the  Drug  Habit. 

Nostrums  and  Quackery  (Published  by  the  American  Medical 

Association). 
See  also  under  subjects  like  Medical  Nursing,  Surgical  Nursing, 

Obstetrical  Nursing,  etc. 

Massage 

TIME:  10  hours  divided  as  follows: — 

Classes  and  Demonstrations — 5  hours. 

Practice  periods — each  group  5  hours. 

Teacher  an  expert  masseuse  preferably  a  trained  nurse. 
Given  as  early  as  possible  in  the  training — not  later  than  the 
early  part  of  the  second  year. 

OBJECTS  OF  THE  COURSE 

1.  To  teach  the  nurse  to  do  ably,  intelligently  and  with  ease 
(without  awkwardness  and  wasted  energy)  such  rubbing  as  is 
necessarily  a  part  of  her  duties  as  a  nurse;  and  to  enlarge  this 
field  somewhat.     (The  nurse  is  not  trained  however,  to  be  a 
specialist  in  massage.) 

2.  To  develop  a  good  touch,  and  a  fair  degree  of  manual 
.              dexterity  in  both  hands. 

3.  To  give  the  nurse  an  intelligent  conception  of  the  full 
scope  of  massage  as  a  therapeutic  measure,  and  to  fit  her  to 
justly  appraise  the  work  of  a  masseuse  employed  for  a  patient 
in  her  charge. 

OUTLINE  OF  CLASSES  AXD  PRACTICE  PERIODS 

I.   (Class)     Introduction 

Object  of  instruction  in  massage  and  growing  importance  of 
this  form  of  treatment.  History  of  massage.  Definitions  and 
nomenclature.  Fundamental  manipulations  common  to  all 
systems  of  massage  analyzed  and  demonstrated.  Review  of 
anatomical  land-marks  and  essential  points  in  anatomy  of 
muscles,  blood  vessels  and  nerves. 

II.   (Practice)     Class  practice  of  simplest  examples  of  the  funda- 
mental manipulations  with  special  reference  to  the  stroking 
movements. 
III.   (Class)     General  Massage 

The  physiological  effects  of  massage — therapeutic  uses  and 
centra-indications  to  use.     General  massage  defined  and  pro- 
cedure outlined.     Preparation  of  patient  and  care  during  and 
after  treatment. 
IV.  (Practice)     General  Massage 


MASSAGE  75 

V  and  VII.  (Class)    Local  Massage 

Conditions  in  which  local  massage  is  used.  Effects  to  be 
produced.  Procedure  in  various  conditions.  Precautions  to 
be  observed  in  abdominal  massage,  massage  of  spine,  joints, 
breast,  etc. 

VI  and  VIII.  (Practice)    Application  of  local  massage  in  above  conditions. 
IX.  (Class)     Medical  Gymnastics 

Various  systems  of  medical  gymnastics.    Active  and  passive 
movements.     Conditions  in  which  used  and  resulting  effects. 
X.  (Practice)    Assistive  and  resistive  movements — circumduction, 
rotation,  flexion,  etc. 

METHODS  OF  TEACHING 

1.  Classes  and  demonstrations  may  be  given  to  fairly  large 
groups,  but  for  practice  work,  class  must  be  divided  into  sec- 
tions of  not  more  than  8  to  10  pupils.    For  small  groups  the 
class  and  practice  may  be  combined  in  one  period. 

2.  It  is  absolutely  essential  that  pupils  should  have  plenty 
of  practice  to  gain  facility  in  the  use  of  the  hand.     Convales- 
cent patients  may  serve  as  subjects  or  pupils  may  practice  on 
each  other.    The  latter  method  is  preferred. 

3.  Questions  and  criticisms  by  the  teacher  serve  to  bring  out 
important  points,    Written   questions  may  be   assigned  for 
students  to  look  up  and  answer.    Both  written  and  practical 
tests  should  be  required  at  the  end  of  the  course. 

4.  Selected  text  and  reference  books  should  be  used,  and  if 
necessary  the  teacher  may  supply  abridged  notes  of  the  essen- 
tial points  and  procedures  covered,  to  economize  the  pupil's 
time  and  secure  accuracy. 

5.  Every  opportunity  should  be  given  for  the  practice  of 
these  procedures  on  the  wards. 

EQUIPMENT  AND  ILLUSTRATIVE  MATERIAL. 

Beds  and  ordinary  bedding  with  extra  light-weight  treatment 
blankets,  chest-blankets,  towels,  sheets,  (small)  pillows,  (small) 
knee  pillows,  hot-water  bag,  lubricant  and  talcum  powder. 
Four  beds  should  be  provided  for  a  class  of  eight. 

TEXT  AND  REFERENCE  BOOKS 

Mitchell  and  Gulick:  Mechano  Therapy  and  Physical  Educa- 
tion. 

Palmer:  Lessons  on  Massage. 
Despard:  Text-Book  of  Massage. 
Cyriax:  Kellgren's  Manual  Treatment. 
McKenzie :  Exercise  in  Education  and  Medicine. 
Graham:  Massage. 


76  OUTLINES    OF   SUBJECTS 

Special  Therapeutics  (Including  Occupation  Therapy) 

TIME:  10  hours — in  lectures,  class  and  demonstration,  by  instructors  who 
are  specialists  in  the  various  branches  discussed. 
Given  in  the  Senior  Year. 

OBJECTS  OF  COURSE 

1.  To  give  the  nurse  a  good  general  idea  of  the  principles 
underlying  the  newer  methods  of  treatment  which  are  to  a  con- 
siderable extent  replacing  the  treatment  by  drugs. 

2.  No  attempt  is  made  here  to  specialize  in  any  of  these 
forms  of  treatment,  but  only  to  enable  the  nurse  to  cooperate 
intelligently  with  those  who  prescribe  and  administer  them 
and  to  show  the  possibilites  of  specialization  which  are  open 
to  nurses. 

OUTLINE  OF  CLASSES 

I.  Hydrotherapy 

History  and  modern  development  of  treatment  by  water. 
Effects  of  temperature  and  pressure  on  skin  and  nervous  sys- 
tem. Indications  and  contra-indications  for  treatment.  Com- 
bination of  hydrotherapy  with  special  climatic  conditions. 
Influence  of  altitude,  temperature  and  moisture  in  air.  Com- 
parative value  of  mountain,  sea-side  and  mineral  springs  for 
various  heart,  kidney,  lung  and  nervous  conditions. 
II.  Practical  Procedures  in  Hydrotherapy 

(Demonstration)  Salt-rubs — mineral  baths — needle  baths — 
sprays  and  douches — packs,  tubs  and  ablutions — local  and 
general. 

III.  Mechanotherapy 

Newer  forms  of  manual  and  mechanical  treatments.  Indica- 
tions and  contraindications  for  treatment.  Physical  exercises. 
Active  games.  Exercising  apparatus.  Equipment,  varieties 
and  value.  Substitutes  where  a  gymnasium  is  not  available. 

IV.  Treatment  by  Light-Rays  and  Electricity 

X-Ray — Radium — Finsen  Light — Heliotherapy — Electrother- 
apy.   The  therapeutic  action  of  these  agents.     Special  indi- 
cations and  contraindications  for  treatment,  precautions  and 
after  care  of  patients. 
V.  Serum-Therapy 

Theories  underlying  the  use  of  serums  reviewed.     Prepara- 
tion of  various  sera.     Methods  of  administration.     Observation 
of  patient.     Prophylaxis  and  anaphylaxis.     (Visit  to  a  research 
laboratory,  if  possible.) 
VI.  Occupation  Therapy 

History  of  the  development  of  work  cures.  Conditions  in 
which  occupation  is  particularly  indicated  as  a  therapeutic 
agent.  Mental  and  physical  effects  of  occupation.  Psycho- 


SPECIAL  THERAPEUTICS  77 

logical  and  physiological  processes  involved.    Economic  and 
moral  aspects  of  occupation  therapy. 
VII  and  VIII.  Choice  of  Occupations 

Factors  to  be  considered  in  choice  of  occupations  for  patients 
— physical  condition,  nature  of  the  disease  or  handicap,  dura- 
tion of  the  disease,  mental  and  manual  equipment,  age,  previ- 
ous life,  personal  tastes  and  capacities,  disposition,  etc.  Main 
types  of  patients  to  be  considered.  Types  of  occupations 
suitable  for  sick  and  handicapped — therapeutic  value  of  each 
— suitability  and  practicability  for  various  types  of  cases — 
mental  and  nervous,  tubercular,  heart  cases,  etc.  Sedentary 
work — embroidery,  basketry,  chair-caning,  modeling,  paper- 
work, string  work,  etc.  Active  indoor  occupations — shop- 
work,  cement,  loom-weaving,  etc.  Outdoor  work — gardening, 
farming,  photography,  etc.  Recreations — entertainments,  dra- 
matic games,  dancing,  music,  reading,  etc. 
IX.  Equipment  and  Materials 

Requirements  in  tools,  materials,  etc.,  needed  for  commoner 
types  of  occupations.  Practical  possiblities  for  the  general 
hospital  patient,  for  sanatoria,  private  cases  and  district  work, 
etc.  Prices  and  purchasing  of  reed,  wood,  paper,  etc.  The 
use  of  waste  materials — rags,  paper,  string,  etc.  Disposal  of 
products. 
X.  Methods  of  Teaching  Occupations 

The  problems  of  bedside  teaching  and  class-teaching.  How 
to  secure  interest  and  cooperation.  Need  of  careful  planning 
and  preparation.  Importance  of  variety.  Dangers  of  over- 
doing. Cultivation  of  originality  and  initiative.  Develop- 
ment of  the  artistic  sense.  Value  of  appreciation  and  com- 
mendation as  incentives.  Encouragement  of  social  motives 
as  opposed  to  commercial  or  individualistic.  Concrete  prob- 
lems provided.  Helping  real  people.  Perfection  in  workman- 
ship comparatively  unimportant.  Educational  and  therapeu- 
tic results  primary  objectives. 

(NOTE).  If  additional  time  can  be  given  and  a  teacher  of 
occupations  can  be  secured,  these  classes  should  be  supple- 
mented by  at  least  10  to  20  hours  in  hand-work.  A  selection 
might  be  made  from  the  following: 

Sewing   and  fancy  work — Knitting,    crocheting,    tatting, 
embroidery,  rug-making,  rake-knitting,  etc. 

Basketry  and  weaving,  using  raffia,  reed,  and  other  mate- 
rials. 

String-work — knotting  and  hammock-making. 

Wood-work — carving  and  simple  construction  in  wood. 

Paper-work — simple  book-binding,  papier  mache  work. 

Leather  work. 


78  OUTLINES   OF   SUBJECTS 

METHODS  OF  TEACHING 

1.  Lecture  and  class  work  should  be  supplemented  by  demon- 
stration as  far  as  possible.    If  more  time  is  available,  students 
should  also  carry  out  the  main  procedures  in  class  to  be  sure 
that  they  have  a  grasp  of  the  principles  of  technic,  otherwise 
practice  should  be  provided  in  connection  with  the  nurse's 
general  work.     Class  visits  to  X-ray  rooms,  hydrotherapeutic 
departments,  etc.,  should  be  made  to  show  the  equipment  in 
operation. 

2.  In  the  occupational  classes  samples  of  the  patient's  work, 
poor  as  well  as  good,  should  be  exhibited  with  brief  histories 
of  the  cases,  showing  how  handicaps  are  overcome  and  therapeu- 
tic results  accomplished.     Nurses  should  be  encouraged  to  make 
themselves  skillful  in  as  many  forms  of  occupational  work  as 
they  can.     Patients  should  be  observed  at  work,   and  case 
records  and  charts  studied  to  trace  the  relation  between  oc- 
cupation prescribed  and  the  patient's  condition. 

ILLUSTRATIVE  MATERIAL  AND  EQUIPMENT 

Samples  of  work,  pictures  of  work-rooms,  of  handicapped 
individuals  at  work,  and  finished  products.  X-ray  plates, 
charts,  apparatus,  etc.,  to  illustrate  subjects  under  discussion. 

TEXT  AND  REFERENCE  BOOKS 

Dunton:  Reconstruction  Therapy. 

Hare:  Practical  Therapeutics. 

Kellogg:  Rational  Hydrotherapy. 

Baruch:  Principles  and  Practice  of  Hydrotherapy. 

Hinsdale:  Hydrotherapy. 

Potts:  Electricity  in  Medicine  and  Surgery. 

Tracy:  Invalid  Occupations 

Tracy:  Rake-Knitting. 

Dunton:  Occupation  Therapy. 

Hall  and  Buck:  The  Work  of  Our  Hands. 

See  also  under  Nursing  in  Mental  and  Nervous  Diseases, 
Materia  Medica  and  Therapeutics^  etc. 

For  Dietary  Treatment  see  under  Diet  in  Disease  p.  22. 


E.  NURSING  IN  DIFFERENT  FORMS  OF  DISEASE 

Elementary  Nursing  Principles  and  Methods 

TIME  :  60  hours,  30  lessons  of  2  hours  each  divided  about  equally  between 
theory  and  practice.  To  be  given  in  the  preparatory  course. 
Teacher — the  nurse  instructor. 

OBJECTS  OF  COURSE 

1.  To  give  a  clear  understanding  of  the  fundamental  princi- 
ples which  underlie  all  good  nursing,  to  develop  habits  of  ob- 
servation,   system,    economy,    and   manual   dexterity  and  to 
establish  a  uniform  an.d  finished  technic. 

2.  To  prepare  pupils  to  meet  the  problems  that  will  confront 
them  in  their  daily  work,  limiting  their  duties  as  far  as  possible 
to  those  which  they  can  understand  and  safely  practice  in  the 
earlier  stage  of  their  training. 

3.  To  test  out  the  aptitude  of  pupils,  with  a  view  to  selecting 
those  who  are  fitted  to  continue  the  work. 

OUTLINE  OF  CLASSES 

I.  Introduction.    How  to  Provide  the  Best  Kind  of  Accommodation 

for  Sick  People. 

Purpose  of  the  hospital  and  kinds.    Importance  of  the  nurs- 
ing service.    What  such  service  includes.     Survey  of  general 
plan  of  the  hospital.    Different  departments  and  their  relation 
to  one   another.    Plan   of  work  to  secure  efficient  service. 
(Class  to  be  taken  on  a  trip  round  the  hospital.) 
II.  The  Patients'  Surroundings.    How  to  Make  Them  Clean,  Com- 
fortable and  Attractive. 

Effect  of  environment  on  sick  people.  The  plan  of  the  ward 
and  private  rooms,  furnishings,  arrangement,  temperature, 
ventilation,  light,  cleaning  and  care.  (If  the  course  in  hospital 
housekeeping  can  not  be  given,  a  longer  time  will  have  to  be 
given  to  this  lesson  and  the  following.) 
III.  Lavatories  and  Service  Rooms.  How  to  Keep  Them  in  Good 

Condition. 

Relation   of  these   to  welfare   of  patient  and  work  of  the 
staff.    Equipment  and  arrangement  of  lavatories,  linen-rooms, 
utility  rooms,  etc.     Care  and  cleaning  of  rooms,  utensils  and 
appliances. 
IV  and  V.  Getting  a  Bed  Ready  for  a  Sick  Patient 

Possible  conditions  to  be  met  in  person  to  occupy  bed.  Kind 
of  bed  and  bedding  needed  in  hospitals  for  comfort,  safety, 
economy,  sanitation,  etc.  Cleaning,  disinfection  and  care  of 
beds  and  bedding.  How  to  make  closed  and  open  bed  and 
children's  cot. 

79 


80  OUTLINES   OP   SUBJECTS 

VI.  How  the  Hospital  Admits  its   Patients    and   Cares  for   Their 

Property 

Types  of  patients  and  how  they  come  to  the  hospital.  What 
can  be  done  to  make  them  feel  at  home  and  save  them  from  fear 
and  worry.  Routine  in  admitting-room,  office  and  ward. 
Clothing  to  be  provided.  Helping  with  tub  bath  and  getting 
patient  to  bed.  Listing  and  caring  for  clothing  and  valuables. 
Precautions  regarding  vermin.  What  the  social  service  de- 
partment does  for  special  cases. 
VII  and  VIII.  How  to  Care  for  the  Patient's  Immediate  Physical  Needs  and 

Make  Him  Comfortable  in  Bed 

Sources  of  discomfort  and  how  to  alleviate  them.  Positions 
of  patients  in  bed.  Devices  for  comfort — pillows,  pads,  rings, 
etc.  Giving  bed-pan.  Lifting  and  turning.  Dressing  and 
undressing.  Changing  bed  with  patient  in  it.  Changing 
mattress  with  patient  in  bed. 
IX .  Moving  and  Carrying  Sick  and  Helpless  Patients 

Condition  of  patients  to  be  specially  considered.  Impor- 
tant points  in  handling  and  carrying  patients.  Assisting  in 
walking.  Carrying  with  and  without  a  stretcher.  Putting 
the  patient  up  on  a  back-rest.  Getting  patient  out  of  doors 
in  a  chair.  Making  bed  for  balcony  patient.  Restraint  for 
irresponsible  patients.  How  and  when  to  restrain. 
X  and  XI.  Bathing  the  Patient 

Purpose  of  the  bath  and  method  of  giving  bed-bath  and  night 
toilet.  Care  of  mouth  and  teeth.  Care  of  nails  and  hands. 
Brushing  and  combing  hair.  Precautions  and  treatment  for 
pediculi.  Washing  the  hair  in  bed.  Care  of  nurse's  basket 
or  tray. 

XII.  Prevention  and  Treatment  of  Bed  Sores.     Relief  of  Common  Dis- 
comforts 

Causes  of  skin  irritations.  Prevention  and  care  of  bed-sores. 
Other  causes  of  restlessness  and  sleeplessness.  How  to  secure 
relaxation.  Regulation  and  treatment  of  visitors.  General 
handling  of  nervous  patients.  Hot-water-bags  and  cold  com- 
presses, etc.  as  aids  to  comfort.  Alcohol  rub  and  simple  rub- 
bing movements. 
XIII.  How  to  Nourish  the  Patient 

Importance  of  food  in  restoring  health.     Physiological  and 

psychological  factors  in  relation  to  appetite.     The  serving  of 

food  to  different  types  of  sick  and  helpless  persons.     Care  of 

food  in  kitchen  and  ward.     Care  of  convalescent  table. 

XIV,  XV  and  XVI.  What  to  Observe  and  Record  About  a  Sick  Patient's 

Condition 

Importance  of  accurate  and  careful  observation.  How  to 
observe.  Cardinal  nymptoins — temperature,  pulse,  respiration, 
and  other  important  indications  of  patient's  condition.  Col- 


ELEMENTARY  NURSING  81 

lection  and  care  of  specimens.     Purpose  of  charts.    Methods 
of  charting.     (Extra  practice  in  printing  to  be  given.) 
XVII.  Assistance  in  Examination  of  the  Patient 

Purpose  of  examination  and  common  procedure  followed. 
What  the  doctor  needs  for  various  types  of  examinations. 
Positions  and  assistance.  How  to  protect  the  patient.  Prep- 
aration for  blood  counts,  Widals,  etc.  How  to  take  the  doc- 
tor's orders. 
XVIII.  Administration  of  Common  Medications 

Special  precautions  in  handling  of  medicines.  Care  of  medi- 
cine tray  and  hypo  tray.  Care  of  medicine  cupboard  and  ap- 
paratus. Administration  of  medicines  by  mouth.  The  ticket 
and  other  systems  for  ensuring  accuracy. 

XIX.  Nursing  Measures  in  Common  Digestive  or  Intestinal  Disturb- 
ances 

Causes  and  treatments  usually  given  for  nausea,  vomiting, 
flatulence,  colic,  etc.    How  to  give  a  simple  enema.     How  to 
irrigate  the  bowel  in  a  child. 
XX.  Nursing  Measures  in  Simple  Infectious  Conditions 

Infectious  nature  of  colds,  coughs,  sore  throats,  etc.  Pre- 
cautions in  care  of  excreta,  linen,  dishes,  etc.  How  to  give 
sprays,  irrigations,  gargles  and  inhalations.  How  to  prepare 
a  croup-tent.  How  to  give  oxygen.  Care  of  room  and  belong- 
ings after  an  infectious  case. 

XXI,  XXII,  XXIII.  Local  Applications  for  Inflammation  and  Congestion 
Condition  of  circulation  in  inflammation.    Action  of  heat 
and  cold.    Application  of  hot-water-bags,  electric  pad,  poul- 
tices,   fomentations,    compresses,  ice-bags,  ice-coils,  etc.,  to 
different  parts.    Action  of  counter-irritants  and  application 
of  mustard  paste.     The  foot  bath,  sitz  bath,  and  mustard  bath. 
XXIV.  The  General  Care  of  Chronic  and  Convalescent  Patients 

Position  and  care  in  chronic  heart-troubles,  asthma,  ascites, 
paralysis,  etc.  Care  of  rheumatics.  Baking  for  stiff  joints. 
Wrapping  joints.  Application  of  liniments.  Simpler  move- 
ments of  massage.  Filling  and  care  of  air  and  water  beds. 
Care  of  convalescents. 
XXV.  The  General  Care  of  Sick  Children  in  the  Hospital 

Special  problems  to  be  met  with  children.  Methods  of 
lifting,  carrying,  bathing,  dressing  and  feeding.  Common 
conditions  and  treatments  in  children's  ward.  The  daily  rou- 
tine. Entertaining  and  managing  sick  children. 

XXVI  and  XXVII.  Elementary  Nursing  Measures  in  Surgical  and  Ortho- 
pedic Conditions 

General  principles  in  surgical  work.  Cleaning  and  steriliza- 
tion of  instruments.  Clearing  trays,  care  of  splints,  sand-bags, 
extensions,  etc.  Making  of  surgical  bed  and  ether  bed.  Care 
of  patient  in  Bradford  frame.  Arm  and  foot  baths  for  surgical 
conditions. 


82  OUTLINES   OF  SUBJECTS 

XXVIII.  Elementary  Nrirsing  Measures  in  Gynecological  Conditions 

Nature  of  conditions  to  be  dealt  with.     Positions  and  mate- 
rials for  examinations  and  treatments.    Douches.     Prepara- 
tion  and   clearing   away   of  catheterization  trays.    Venereal 
precautions. 
XXIX.  Elementary  Measures  in  Eye,  Ear  and  Skin  Cases 

Nature  of  conditions  to  be  cared  for.  Eye-bathing,  com- 
presses and  drops.  Removal  of  foreign  bodies  in  eye.  Prep- 
aration of  trays  for  eye  and  ear  treatments.  Application  of 
ointments  and  lotions  for  common  skin  troubles.  Eczema 
masks.  Care  of  infectious  skin  conditions. 
XXX.  Special  Problems 

How  the  hospital  discharges  its  patients.  Getting  the  pa- 
tient ready  to  go  home.  Routine  of  discharge.  Assistance  by 
social  service  department  in  special  cases.  What  to  do  in  case 
of  approaching  death.  The  care  of  the  body.  Disposal  of 
clothing,  valuables,  etc.  Care  of  delirious  patients.  Night 
care  of  sick  patients. 

NOTE.  It  is  very  desirable  that  some  additional  time  should 
be  given  in  connection  with  this  course  for  a  brief  discussion 
of  occupations  and  diversions  for  ward  patients.  Pupils  can 
teach  each  other  many  of  these  processes,  and  if  their  interest 
is  once  aroused  they  will  begin  at  once  to  devise  and  learn 
new  ways  of  employing  their  patients'  idle  hands  and  minds. 
Some  practical  application  of  the  simpler  games  and  common 
forms  of  hand-work  could  be  made  in  the  daily  work  in  the 
wards  and  dispensary.  The  special  therapeutic  effects  of  occu- 
pation would  not  be  discussed  here.  The  main  points  to  be 
covered  are  as  follows: 

1.  How  to   occupy   the   patient's   mind.     The   mental   and 
physical  effects  of  idleness  both  on  well  and  sick  people — the 
special  need  for  diversion  and  occupation  in  certain  types  of 
disease,  as  an  antidote  to  worry  and  a  source  of  interest  and 
mental  stimulation.     Use  of  books  and  pictures  in  the  hospital. 
Choice  of  stories  and  anecdotes  for  different  ages  and  types  of 
patients,  bed  games,  cards,  puzzle-pictures,  floor  and  table 
games,  checkers,  chess,  dominoes,    block-building,    etc.     The 
storing  and  care  of  materials  in  the  wards.     The  use  of  waste 
materials. 

2.  Suggested  occupations  for  special  types  of  patients  in  the 
hospital.     Hand-work,  entertainment  and  diversions,  suited  to 
children,  women,  men,  and  patients  with  special  handicaps. 

(For  equipment,  reference-books,  etc.,  see  under  Special 
Therapeutics.) 

METHOD  OF  TEACHING 

1 .  In  order  to  insure  complete  understanding  of  the  principles 
involved,  about  half  the  time  will  usually  be  required  to  ques- 


ELEMENTARY  NURSING  83 

tion  the  students  and  explain  the  purpose  of  the  various  treat- 
ments, the  conditions  in  which  each  is  used,  the  effects  to  be 
looked  for  and  the  precautions  required.  The  demonstration 
should  follow  or  accompany  this  part  of  the  lesson,  and  might 
be  given  to  the  whole  class  unless  it  is  very  large. 

2.  For  practice  work,  the  class  should  be  divided  into  sections 
of  from  eight  to  twelve  pupils,  depending  on  the  amount  of 
equipment  available.    For  all  the  commoner  procedures  each 
pupil  should  have  an  individual  set  of  appliances  as  in  the  diet 
kitchen,  but  if  this  is  not  possible  pupils  can  work  in  groups  of 
two  or  three.    The  teacher  supervises  the  practice  work,  quiz- 
zing the  pupils  and  explaining  where  necessary.    Pupils  may 
be  asked  to  criticize  each  other's  work,  and  sometimes  to  dem- 
onstrate for  the  group.     Frequent  reviews  are  desirable,  and 
a  final  demonstration  before  the  superintendent  and  head  nurses 
is  often  found  to  stimulate  careful  and  finished  work. 

3.  If  the  pupils  are  regularly  assigned  to  ward  duty,  much  of 
the  practice  or  drill  can  be  carried  on  in  the  wards  under  the 
general  supervision  of  the  instructor.     If  the  student  is  not  on 
ward  duty,  extra  hours  will  have  to  be  allowed  for  practice  work 
in  the  demonstration  room  till  skill  and  confidence   are  de- 
veloped.   Pupils  should  not  be  allowed  to  perform  any  duties 
in  the  wards  till  the  method  has  been  thoroughly  taught  in  the 
demonstration  room.    This  method  should  be  the  one  in  use 
throughout  the  hospital. 

4.  To  secure  uniformity  in  method,  it  is  well  to  have  a  type- 
written or  printed  book  of  standardized  procedures  for  reference 
in  each  ward.    These  methods  should  be  carefully  worked  out 
to  secure  the  greatest  safety,  comfort,  and  best  therapeutic 
results  for  the  patient,   and  the  greatest  economy  in  time, 
effort  and  materials  for  the  staff  and  the  hospital.    Neatness 
and  simplicity  of  procedure  are  also  of  primary  importance. 

5.  It  is  desirable  that  the  nursing  procedures  taught  in  the 
probationary  period  should  include  only  the  simpler  and  less 
technical  treatments,  those  which  do  not  demand  fine  skill  or 
much  experience  and  understanding  of  disease,  and  those  which 
would  not  likely  be  misused  if  the  pupil  is  not  retained  in  the 
hospital.     If  it  is  absolutely  necessary  for  pupils  to  be  given 
more  responsible  work  such  as  night  duty  immediately  follow- 
ing the  preparatory  course,  certain  other  procedures  may  have 
to  be  taken  up  in  this  elementary  course,  such  as  catherization, 
hot  and  cold  packs,  intestinal  irrigation,  nutrient  enema,  etc. 
It  is  advisable  however  to  defer  these  till  the  pupil  has  had 
more  experience  and  knowledge  and  till  she  has  properly  mas- 
tered the  fundamentals  as  outlined  above.    Courses  in  medical 
and  surgical  nursing  should  follow  this  elementary  course. 


84  OUTLINES   OF  SUBJECTS 

EQUIPMENT  AND  ILLUSTRATIVE  MATERIAL 

1.  A  special  demonstration  room  or  laboratory  should  be 
fitted  up  for  the  teaching  of  practical  nursing.    This  should  be 
large  enough  to  allow  eight  to  twelve  students  to  work  freely 
at  one  time.     It  should  have  ample  cupboard  and  drawer  space 
for  supplies,  and  several  good-sized  tables,  as  well  as  black- 
boards, chairs,  etc. 

2.  The  demonstration  room  should  contain  a  complete  equip- 
ment of  the  materials  needed  for  class  work — beds,   linen, 
enamel  and  glass-ware,  drugs  and  supplies.     For  all  the  com- 
moner procedures  each  pupil  or  pair  of  pupils  should  have  an 
individual  set  if  possible.    Expensive  or  cumbersome  articles 
can  be  borrowed  from  the  wards,  when  needed.    Sometimes  it 
is  possible  to  use  an  empty  ward  or  a  good-sized  private  room 
as  a  practice  room  and  then  ward  supplies  and  equipment  may 
be  used. 

3.  Demonstration  dolls  or  manikins  can  be  used  for  many 
demonstrations,  though  the  living  subject  is  better  if  one  can 
be  secured.     Pupils  can  be  used  as  subjects  in  many  procedures. 
A  home-made  life-size  doll  can  be  made  quite  inexpensively, 
covered  with  single-faced  rubber  so  that  it  can  be  bathed  and 
tubbed  if  desirable. 

4.  Anatomical  charts  and  models,  the  skeleton,  and  other 
illustrative  material  will  be  needed. 

(For  plan  and  equipment  of  demonstration  room  see  articles 
in  1914  and  1915  Reports  of  National  League  of  Nursing 
Education,  also  The  Modern  Hospital,  June,  1918.) 

TEXT  AND  REFERENCE  BOOKS 

Nightingale:  Notes  on  Nursing. 
Maxwell  and  Pope:  Practical  Nursing. 
Sanders:  Modern  Methods  in  Nursing. 
Robb:  Nursing — Principles  and  Practice. 
Mclsaac:  Primary  Nursing  Technique. 
Brown:  The  Junior  Nurse. 
Bridge:  Nursing  Manual. 
Wheeler:  Nursing  Technic. 

See  also  books  on  Anatomy  and  Physiology,  Bacteriology, 
Chemistry,  Physics,  Hygiene,  and  Medical  and  Surgical  Nurs- 
ing. 

Elementary  Bandaging 

TIME:  10  hours.  Class,  demonstration  and  practice  in  two-hour  periods. 
Taught  by  the  instructor  of  nurses  or  a  competent  head-nurse. 
Given  in  the  preparatory  course.  (May  be  combined  with 
course  in  practical  nursing). 


ELEMENTARY   BANDAGING  85 


OBJECTS  OF  THE  COURSE 

1.  To  teach  the  fundamental  principles  of  good  bandaging 
as  a  basis  for  all  future  practice  in  connection  with  surgical 
and  orthopedic  work,  first  aid,  etc. 

2.  To  develop  a  fair  degree  of  manual  dexterity  and  skill 
in  the  application  of  the  commoner  and  simpler  bandages. 

OUTLINE  OF  CLASSES 

I.  Introduction 

Purposes  for  which  bandages  are  used.  Variations  in  mate- 
rials, width,  length,  etc.,  of  roller  bandages.  How  to  make 
and  roll  bandages.  Triangular,  cravat,  four-tailed,  and  sculte- 
tus  bandages.  Their  uses  and  common  applications.  Slings 
of  different  types  and  their  application.  Knots. 
II.  The  Circular  and  Spiral  Bandage,  and  the  Spica  (Hand  and  Arm) 

Methods  of  holding,  starting  and  ending  the  roller  bandage. 
Circular  bandage  of  the  wrist,  spiral  of  the  arm  and  finger, 
spica  of  the  thumb,  complete  gauntlet  of  the  hand  and  demi- 
gauntlet. 

III.  The  Spiral  Reverse  and  Figure-of-Eight  of  the  Arm 

Purpose  and  technic  of  the  reverse.  Spiral  reverse  of  the  arm, 
figure-of-eight  of  the  arm  and  elbow  (including  the  hand), 
spica  of  the  shoulder. 

IV.  Spiral  Reverse  and  Figure-of-Eight  of  Leg  and  Foot 

Spiral  reverse  of  leg.    Spica  of  the  foot  (covering  the  heel). 
Figure-of-eight  of  the  ankle.    Figure-of-eight  of  the  leg.    Spica 
of  the  groin. 
V.  Special  Bandages  of  the  Head  and  Chest 

Figure-of-eight  of  the  shoulders  and  chest.  Suspensory  of 
the  breast  (single  and  double).  Recurrent  head-bandage. 
Oblique  of  the  jaw.  Barton's  bandage  and  eye-bandage. 

METHODS  OF  TEACHING 

1.  The  class  period  should  be  devoted  largely  to  demonstra- 
tion and  practice,  with  criticism  by  the  teacher.     When  the 
pupil  has  caught  the  right  idea,  the  necessary  extra  practice 
to  acquire  speed  and  dexterity  can  be  done  outside  the  class- 
room. 

2.  Pupils  may  practice  on  each  other  where  this  does  not 
necessitate  a  great  waste  of  time  for  the  model.    It  is  better  to 
have  the  human  model  to  practice  on,  but  fairly  satisfactory 
work  can  be  done  on  wooden  or  plaster-of-paris  models  (see 
below)  or  on  the  doll  until  the  method  is  acquired. 

3.  Books  or  charts  with   good  illustrations  of  bandaging 
technic  should  be  used  freely  by  the  pupils  to  supplement 
demonstrations  by  the  teacher. 


86  OUTLINES   OF   SUBJECTS 

EQUIPMENT  AND  ILLUSTRATIVE  MATERIAL 

1.  Bandages  of  all  varieties  should  be  available  for  demon- 
stration and  for  use  by  pupils. 

2.  Models  of  head,  arm,  leg,  hand,  etc.,  may  be  secured  and 
mounted  in  convenient  positions  for  practice. 

3.  Improvised  models  may  be  made  by  pouring  plaster-of- 
paris  into  a  firm  glove  or  stocking  and  moulding  quickly  to 
the  shape  desired.     Plaster-of-paris  models  of  heads  may  also 
be  made  at  small  cost. 

TEXT  AND  REFERENCE  BOOKS 

Eliason:  Practical  Bandaging. 
Davis:  Principles  and  Practice  of  Bandaging. 
Hopkins:  The  Roller  Bandage. 
Wharton:  Minor  Surgery  and  Bandaging. 
Morrow:  Immediate  Care  of  the  Injured. 
See  also  under  Surgical  and  Orthopedic  Nursing. 

Elements  of  Pathology 

TIME  :  10  hours.  Lecture,  class  and  laboratory  work,  conducted  by  pathol- 
ogist with  assistance  of  instructor  if  necessary.  Second  term 
of  first  year. 

OBJECTS  OF  COURSE 

It  is  not  the  intention  here  to  make  the  nurse  technically 
skillful  in  performing  laboratory  tests,  but  rather  to  help  her 
to  understand  the  principal  causes  that  lead  to  disease,  the  na- 
ture of  some  of  the  commoner  disease  processes,  the  meaning  of 
terms  used  in  describing  pathological  conditions,  and  the 
importance  of  the  various  diagnostic  measures  especially  as  they 
touch  her  work.  If  she  understands  these  things  she  will  boa 
better  observer  of  symptoms,  more  intelligent  in  applying  treat- 
ments, and  will  be  able  to  cooperate  intelligently  with  the  phy- 
sician and  the  pathologist  in  such  tests  and  experiments  as  they 
wish  to  carry  out  on  the  wards. 

OUTLINE  OF  CLASSES  AND  DEMONSTRATIONS 

I.  General  Features  of  Diseases 

Brief  review  of  history  of  pathology.  Classification  of  dis- 
eases according  to  effect  on  the  body  (functional  and  organic), 
origin  (constitutional  and  environmental)  and  nature  of  disease. 
Causes  classified  into  predisposing  (heredity,  environment, 
climate,  age,  sex,  occupation,  etc.)  and  direct  or  exciting  (me- 
chanical, physical,  chemical,  and  parasitic) .  Examples  of  each. 
Meaning  of  immunity,  susceptibility,  predisposition,  and  idio- 
syncrasy. Role  of  bacteria  and  animal  parasites  reviewed. 
Effects  of  bacteria  on  the  tissues. 


ELEMENTS  OF  PATHOLOGY  87 

II  and  III.  Disease  Processes  or  Conditions 

Congenital  (malformations,  weaknesses,  defects,  etc.).  Dis- 
orders of  digestion  and  metabolism  (faulty  digestion,  elimina- 
tion or  secretion).  Disturbances  of  circulation  (heart  lesions, 
congestion,  haemorrhage,  thrombosis,  oedema,  etc.).  Retro- 
grade processes  (atrophy,  degeneration,  necrosis,  gangrene, 
death).  Progressive  processes  (hypertrophy).  Inflammation 
• — symptoms,  causes,  processes  (hyperemia,  exudation,  diape- 
desis,  resolution,  suppuration,  ulcer,  abscess,  sinus,  etc.).  Proc- 
esses of  tissue  rapair.  Results  of  reparative  processes. 
IV.  New  Growths 

Tumors — cause,  structure,  nature  (benign  and  malignant), 
dangers,  varieties  (lipoma,  fibroma,  dermoid  cyst,  sarcoma, 
carcinoma).  Tumor-like  growths  (gummata  in  syphilis,  tuber- 
cles in  tuberculosis,  and  nodules  in  leprosy),  cavities  (tubercu- 
losis and  dental  caries).  False  membranes,  strictures  and 
adhesions. 
V  and  VI.  Observation  of  Symptoms  (Aids  to  Clinical  Diagnosis) 

Importance  of  correct  observation  and  accurate  description 
of  symptoms' — objective  and  subjective.  Important  symptoms 
relating  to  central  nervous  system,  special  senses,  respiratory 
tract,  alimentary  tract,  vascular  system,  organs  of  elimination, 
muscular  system,  bony  system,  reproductive  system,  and  duct- 
less glands.  Purpose  and  care  of  the  stethoscope,  sphygmo- 
manometer,  and  other  apparatus  used  in  clinical  diagnosis. 
VII.  Methods  of  Laboratory  Diagnosis 

Methods  of  obtaining  and  preserving  specimens  for  examina- 
tion. General  purpose  and  significance  of  tests  made  in  patho- 
logical laboratory  (blood,  dropsical  fluid,  spinal  fluid,  pus, 
sputum,  vomitus,  feces,  urine,  vaginal  smears,  throat  cul- 
tures, and  specimens  from  operating  room).  Interpretation  of 
results.  Charting. 
VIII.  Examination  of  Feces  and  Gastric  Contents 

Normal  stools' — number,  form,  consistency,  color.  Gross  ap- 
pearance of  pathological  stools,  with  mucus,  pus,  blood,  para-, 
sites,  calculi,  foreign  bodies.  Clinical  significance.  Purpose 
of  commoner  tests.  Appearance  of  normal  stomach  contents,. 
Nature  of  tests.  Charting. 
IX.  Examination  of  Urine. 

Appearance  of  normal  urine — quantity,  color,  turbidity,  odor, 
reaction,  specific  gravity,  and  constituents.  Abnormal  urine 
• — conditions  producing  changes  in  composition,  quantity,  spe- 
cific gravity,  etc.  Nature  of  chemical  tests — for  sugar,  albu- 
min, indican,  and  bile.  Nature  of  microscopic  tests — for  crys» 
tals,  pus,  casts,  bacteria,  etc.  Charting. 
X.  Laboratory  Period 

Students  divided  into  groups  make  simple  tests  of  normal  and 
abnormal  urine. 


88  OUTLINES   OF   SUBJECTS 

METHOD  OF  TEACHING 

1.  Classes  should  be  held  in  the  pathological  laboratory  or 
museum  where  students  can  be  shown  specimens  illustrating 
the  conditions  and  processes  described.    Lantern  slides  can 
also  be  used  to  great  advantage. 

2.  This  course  is  a  continuation  of  the  courses  in  Anatomy, 
Bacteriology,  and  Chemistry  which  were  given  in  the  prepara- 
tory term,  and  is  intended  to  serve  as  a  basis  for  the  courses  in 
Medical  and  Surgical  Nursing.    It  should  therefore  be  corre- 
lated closely  with  these  subjects. 

3.  It  is  important  that  pupils  should  get  a  good  command  of 
all  the  ordinary  terms  used  in  describing  disease  conditions — 
their  spelling,  pronunciation,  and  their  exact  meaning.     Hence 
it  is  advisable  to  have  brief  written  and  oral  reviews  and  quizzes 
when  possible. 

ILLUSTRATIVE  MATERIAL 

Pathological  specimens,  slides,  charts,  X-ray  photographs, 
and  illustrations  from  books.  Microscopes. 

TEXT  AND  REFERENCE  BOOKS 

Roberts:  Bacteriology  ahd  Pathology  for  Nurses. 

Sedgwick:  Principles  of  Sanitary  Science. 

Roger:  Principles  of  Medical  Pathology. 

Adami  and  McCrea:  Textbook  on  Pathology. 

Wells:  Chemical  Pathology. 

Henry:  A  Nurse's  Handbook  of  Medicine. 

Emerson:  Essentials  of  Medicine. 

Councilman:  Disease     and     Its    Causes.     (Home   University 

Library) 

Mackenzie:  Health  and  Disease.     (Home  University  Library). 
Mackenzie:  Symptoms  and  their  Interpretation. 
Medical  Dictionaries. 
See    also    books    on    Bacteriology,    Medicine,    Surgery,    and 

Hygiene. 

Nursing  In  Medical  Diseases 

TIME:  20  hours,  divided  as  follows: 

Lectures  a.nd  clinics  by  physicians — 10  one-hour  periods. 
Classes   and   demonstrations   by   nurse   instructor — 10  one- 
hour  periods.     Given  in  the  second  half  of  the  first  year. 

OBJECTS  OF  COURSE 

1.  To  give  the  nurse  a  practical  understanding  of  the  causes, 
symptoms,  prevention  and  treatment  of  the  commoner  medical 
diseases,  so  that  she  may  intelligently  care  for  her  patients,  and 
give  skilled  assistance  to  the  physician. 


NURSING  IN  MEDICAL  DISEASES  89 

2.  To  give  her  skill  and  precision  in  the  administration  of  the 
more  advanced  nursing  treatments  and  to  make  her  a  keen 
observer  and  reporter  of  the  symptoms  of  disease  and  the  effects 
of  treatments. 

OUTLINE  OF  LECTURES  AND  CLASSES 

I  and  III.  (Lectures)     Diseases  of  the  Blood,  Heart  and  Circulatory  System 
Anaemia,    leukaemia,    chlorosis,    pericarditis,    endocarditis, 
myocarditis,    valvular    diseases,    arteriosclerosis,    aneurism, 
phlebitis. 

II  and  IV.  (Classes)  Quiz  on  lectures.  General  nursing  measures  used 
in  above  conditions — diet,  drugs,  appliances,  etc.  Symptoms 
to  be  observed.  Special  treatments.  Administration  of  drugs 
by  hypodermic.  Hypodermoclysis,  transfusion,  and  intra- 
venous. Saline  infusion. 
V  and  VII.  (Lectures)  Diseases  of  the  Respiratory  System 

Pneumonia,  broncho-pneumonia,  pleurisy,  empyema,  pneu- 
mo-thorax,  oedema,  bronchitis,  bronchial  asthma,  etc. 

VI  and  VIII.  (Classes)  Quiz  on  lectures.  General  nursing  measures  re- 
quired in  above  conditions.  Review  treatments  such  as  in- 
halations, croup-tent,  irrigations,  oxygen,  etc.,  adding,  cupping, 
actual  cautery,  cantharides,  leeches,  and  special  counter- 
irritants.  Administration  of  pneumonia  serum. 

IX,  XI,  XIII.  (Lectures)     Diseases  of  the  Gastro-Intestinal  Tract  and  Acces- 
sory Organs 

Gastritis,  dilatation  of  stomach,  duodenal  ulcer,  carcinoma 
of  stomach,  haematemesis,  gastric  neurosis,  constipation,  diar- 
rhoea, mucous  colitis,  chronic  appendicitis,  ascites,  jaundice, 
cirrhosis  and  carcinoma  of  the  liver,  etc.  (Typhoid  should  be 
included  here  if  pupils  are  likely  to  care  for  such  cases  early. 
See  communicable  diseases.) 

X,  XII,  and  XIV.  (Classes)  Quiz  on  lectures.  General  nursing  measures 
required  in  above  conditions.  Special  treatments — test  meals, 
lavage,  gavage,  nasal  feeding,  intestinal  irrigations,  procto- 
clysis,  rectal  feeding.  Antipyretic  measures — cold  sponge, 
slush  bath,  cold  pack. 

XV,  XVII,  and  XIX.     (Lectures)     Diseases  of  the  Urinary  Tract  and 

Constitutional  Diseases 

Nephritis,  uraemia,  cystitis,  rheumatism,  gout,  diabetes, 
and  diseases  of  the  special  glands. 

XVI,  XVIII,  and  XX.  General  nursing  measures  required  in  above  con- 

ditions. Catherization,  bladder  irrigation,  instillation,  cysto- 
scopic  examination.  Diaphoretic  treatments — hot  pack,  vapor 
and  hot  air  baths,  medicated  baths. 

NOTE.  If  it  is  impossible  to  combine  the  medical  lecture 
and  nursing  classes  in  this  way  for  each  group  as  it  finishes  the 
preliminary  course,  it  is  suggested  that  the  nursing  classes  be 


90  OUTLINES   OF   SUBJECTS 

given  separately  to  each  group,  and  that  all  groups  be  combined 
for  the  medical  lectures.  Where  the  medical  lectures  have  to  be 
postponed  till  the  second  year,  the  nursing  classes  should  in- 
clude a  summary  of  the  principal  medical  diseases  such  as  is 
found  in  most  nursing  text  books.  The  course  in  pathology 
should  precede  or  accompany  the  course  in  medical  nursing. 
Practical  experience  in  the  general  medical  wards  should  be 
given  early  to  all  pupils,  as  it  is  fundamental  to  all  the  special 
branches  of  nursing. 

METHODS  OF  TEACHING 

1.  The  clinical  method  of  teaching  medical  diseases  is  to  be 
preferred  wherever  it  is  possible.     Lectures  and  classes  should 
be  illustrated  constantly  by  reference  to  patients  in  the  wards 
and  nurses  quizzed  on  the  cases  from  their  own  wards.     Short 
written  reports  on  interesting  cases  may  be  read  in  class  by 
pupils. 

2.  The  anatomy  and  physiology  of  each  system  should  be 
assigned  for  review  before  taking  up  the  diseases  of  each  system. 
Quizzes  should  include  previous  related  work  in  bacteriology, 
hygiene,  materia  medica,  dietetics,  etc. 

3.  In  the  short  time  allowed  it  will  not  be  possible  for  nurses 
to  practice  the  nursing  procedures  in  the  class-room.     However 
each  nurse  should  be  given  an  opportunity  as  soon  as  possible, 
to  carry  out  each  procedure  on  the  ward.     No  treatment  should 
be  given  the  first  time  without  observation  by  the  head  nurse 
or  instructor.     The  pupil's  card  should  be  marked  up  when  the 
treatment  has  been  given  satisfactorily  and  care  should  be 
taken  to  see  that  no  important  procedure  is  omitted. 

4.  Charting  should  be  emphasized  in  connection  with  every 
lesson  and  typical  charts  studied  in  connection  with  the  differ- 
ent diseases. 

EQUIPMENT  AND  ILLUSTRATIVE  MATERIAL 

Laboratory  specimens  showing  diseased  organs,  charts, 
diagrams,  X-ray  plates,  lantern  slides,  skeleton,  bones,  etc. 
Demonstration  room  equipment. 

TEXT  AND  REFERENCE  BOOKS 

Emerson:  Essentials  of  Medicine. 
Robb:  Nursing  Principles  and  Practice. 
Maxwell-Pope:  Practical  Nursing. 
Sanders:  Modern  Methods  in  Nursing. 
Wheeler:  Nursing  Technique. 
Osier:  Practice  of  Medicine. 
Hughes:  Practice  of  Medicine. 
Stevens:  Practice  of  Medicine. 


NURSING   IN   SURGICAL  DISEASES  91 

Rosenau:  Preventive  Medicine  and  Hygiene. 

Hare:  Practical  Therapeutics. 

H^nsdale:  Hydrotherapy. 

Baruch:  Principles  and  Practice  of  Hydrotherapy. 

Brunton:  Lectures  on  the  Action  of  Medicines. 

Farr:  Internal  Medicine. 

Lee:  Scientific  Features  of  Modern  Medicine. 

See  also  reference  books  on  Pathology,  Materia  Medica, 
Dietetics,  etc. 

Nursing  in  Surgical  Diseases 

TIME  :  20  hours  divided  as  follows  : 

Lectures  or  clinics,  conducted  by  a  surgeon — 10  hours. 
Nursing  classes,  quizzes  and  demonstrations,  conducted  by 
an  expert  surgical  nurse — 10  hours. 

OBJECTS  OP  COURSE 

1.  To  give  the  pupil  nurse  a  good  general  idea  of  the  nature 
of  the  principal  surgical  diseases,  their  symptoms  and  treat- 
ment, so  that  she  may  care  for  surgical  patients  intelligently, 
be  of  the  greatest  possible  assistance  to  the  surgeon  in  dressings 
and  surgical  treatments,  and  be  able  to  act  promptly  and  wisely 
in  emergencies. 

2.  To  give  her  skill  in  elementary  surgical  procedures  and 
bandaging,  and  to  establish  good  habits  of  surgical  technic. 

OUTLINE  OP  LECTURES  AND  CLASSES 

I.  (Lecture)    Introduction 

History  of  antiseptic  and  aseptic  surgery.  Microorganisms 
specially  concerned  in  wound  infections.  Sources  and  modes  of 
infection.  Surgical  nomenclature.  Outline  of  the  surgical 
field.  General  principles  of  modern  surgery. 
II.  (Class)  Essential  qualifications  for  success  in  surgical  nursing. 
Surgical  materials  and  their  preparation.  Sterilization  of 
surgical  instruments  and  dressings.  Skin  disinfection  and 
surgical  toilet.  Care  of  the  dressing  carriage  and  dressing  room. 

III.  (Lecture)  Wounds  and  Wound  Infections 

Kinds  of  wounds — accidental  and  operative — clean  and 
infected.  The  healing  process.  Pathological  conditions — in- 
flammation, suppuration,  necrosis,  gangrene,  septicaemia, 
pyaemia,  erysipelas,  tetanus.  Burns  and  scalds. 

IV.  (Class)    Surgical   dressings   in   clean   and   infected  wounds. 
Wet  dressings.     Packing,  drainage,  and  special  applications. 
Removal  of  sutures.     Treatment  of  contusions.    Nursing  care 
of  burn  cases.     Setting  up  of  surgical  trays  for  various  kinds  of 
dressings. 


92  OUTLINES  OF  SUBJECTS 

V.  (Lecture)  Surgical  Emergencies 

Hemorrhage — causes,  symptoms,  and  treatment.    External 
and    internal    hemorrhage.    Shock — causes,    symptoms    and 
treatment.    Theory  and  technic  of  anoci  association. 
VI.  (Class)    Methods  of  controlling  hemorrhage  by  digital  pres- 
sure, position,  toruniquet,  etc.    After  treatment  of  hemorrhage. 
Prevention  and  treatment  of  shock. 
VII.  (Lecture)  Minor  Surgical  Procedures 

Local  incisions  for  abcesses,  empyema,  tracheotomy.     Tech- 
nic of  exploration,  lumbar  puncture,  phlebotomy,  aspiration, 
paracentesis,  etc.     Local  anaesthetics. 
VIII.  (Class)  Preparation   for  local   incisions   and  operations   and 

after  care.     Provision  for  drainage.     Biers  cups. 
IX.  (Lecture)    Major  Surgical  Operations  and  Surgical  Complica- 
tions 

Preparation  of  patient  for  operation.  General  care  during 
and  after  operation.  Post-operative  complications — nausea, 
vomiting,  tympanites,  auto-intoxication,  pulmonary  and 
kidney  complications,  hemophilia,  thrombosis,  embolism,  phle- 
bitis, etc. 

X.  (Class)  Review  ether-bed,  Fowler's  position  and  general  points 

as  to  routine  nursing  care  and  treatment  in  major  operations. 

Observation  of  symptoms.    How  to  keep  surgical  charts  and 

records.     Treatment  of  surgical  complications. 

XI.   (Lectures)     Surgical  Conditions  Involving  Bony  and  Muscular 

Systems 

Fractures,  dislocations  and  sprains.  Amputations  of  ex- 
tremities. Necrosis  and  osteomyelitis.  (Orthopedic  conditions 
discussed  in  special  course.) 

XII.  (Class)  Review  of  fracture  bed,  splints,  extensions,  etc. 
Preparation  and  after  care  rh  each  type  of  operation  or  injury, 
especially  fractures  of  skull,  spine,  pelvis,  and  compound 
fractures.  Special  bandages — Velpeau,  stump,  ankle,  etc. 
Strapping  for  sprained  ankle,  knee,  etc. 

XIII.  (Lecture)    Surgical  Conditions  of  the  Alimentary   Tract  and 

Accessory  Organs 

Common  operative  procedures  involving  stomach,  spleen, 
liver,  and  intestines.  Operations  for  ulcer  and  cancer  of  stom- 
ach and  intestines,  intestinal  obstruction,  tubercular  peri- 
tonitis, appendicitis,  hernia,  gallstones,  etc. 

XIV.  (Class)     Preparation  for  above,  procedures  and  after  care  in 
each  type  of  operation.     Bandages    and    dressings.    Special 
nursing  care  of  fecal  fistula,  gall-bladder  and  hernia  cases. 
Charting. 

XV.  (Lecture)    Surgical  Conditions  of  Thorax  and  Back 

Operations  on  chest,  breast  and  kidney,  including  sarcoma, 
carcinoma,  cysts,  tumors,  stone,  etc.  (Brief  survey  of  surgery 
of  genito-urinary  tract  given  here.  To  be  treated  more  fully 
later  in  a  special  course.) 


NURSING   IN   COMMUNICABLE   DISEASES  93 

XVI.  (Class)    Preparations  and  after  care  in  each  type  of  operation. 

Special  bandages  and  dressings.    Charting. 
XVII.  (Lectures)    Surgery  of  the  Head  and  Spinal  Cord 

Surgical  conditions  of  brain  and  spinal  cord,  mouth,  tongue, 
and  thyroid  gland. 
XVIII.  (Class)     Preparation  and  after  care  in  each  type  of  operation. 

Special  dressings  and  bandages.     Charting. 
XIX.  (Lecture)    Plastic  Surgery 

Grafts — bone  and  skin.  Surgical  treatment  of  hare-lip, 
cleft  palate,  etc. 

XX.  (Class)  Preparation  and  after  care  in  each  type  of  operation. 
Special  dressings  and  bandages. 

METHOD  OF  TEACHING 

Follow  same  general  method  as  that  outlined  under  medical 
nursing. 

EQUIPMENT  AND  ILLUSTRATIVE  MATERIAL 

Dressing  carriage  and  full  equipment  of  surgical  materials. 
Trays  for  various  types  of  surgical  dressings,  hypodermoclysis, 
preparation,  etc.  Samples  of  special  instruments  and  appara- 
tus. Lantern  slides,  X-ray  plates,  skeleton,  etc.  Anatomical 
and  first  aid  charts. 

TEXT  AND  REFERENCE  BOOKS 

Parker  and  Breckenridge :  Surgical  and  Gynecological  Nursing. 
Fowler:  Operating  Room  and  Patient. 
Howell:  Surgical  Nursing  and  Hospital  Technique. 
Rose  and  Carless:  Manual  of  Surgery. 
DaCosta:  Modern  Surgery — General  and  Operative. 
Morrow:  Immediate  Care  of  the  Injured. 
Saleeby:  Surgery  and  Society. 
Crile:  Anoci-Association. 
See  also  under  Elementary  Bandaging  and  First  Aid. 

Nursing  in  Communicable  Diseases 

TIME  :  20  hours — divided  as  follows : 

Medical  lectures  or  clinics  by  a  physician — 9  hours. 

Medical  classes  and  demonstrations,  by  a  nurse  who  is  a 
specialist  in  the  field — 9  hours. 

Lectures  on  social  aspects  by  social  service  worker  or  special- 
ist in  this  phase  of  the  subject — 2  hours.  Course  to  be  given 
in  the  earlier  half  of  the  second  year. 

OBJECTS  OF  COURSE 

1.  In  most  infectious  diseases,  the  nursing  care  is  the  most 
important  part  of  the  treatment,  hence  the  nurse  needs  to  be 
thoroughly  informed  on  the  nature  of  these  diseases,  and  on 
every  point  that  would  help  her  to  give  intelligent  nursing 
care  and  to  prevent  the  spread  of  disease  to  others. 


94  OUTLINES   OF  SUBJECTS 

2.  Especially  in  public  health  nursing,  the  nurse  is  expected 
to  detect  the  early  signs  of  the  infectious  diseases,  so  she  ought 
to  be  very  familiar  with  the  symptoms  of  all  the  commoner 
infections,  and  should  know  the  local  regulations  for  the  han- 
dling of  such  cases. 

3.  It  is  very  important  that  she  should  also  recognize  the 
social  and  economic  aspects  of  this  whole  question  of  prevent- 
able diseases,  and  should  appreciate  her  responsibilities  and 
opportunities  in  the  campaign  to  eradicate  them. 

OUTLINE  OF  LECTURES  AND  CLASSES 

I.   (Lecture)  Typhoid  Fever 

Introduction  to  the  study  of  fevers.  General  clinical  fea- 
tures, causes,  stages  and  general  lines  of  prophylaxis  and  treat- 
ment. The  causes,  modes  of  transmission,  incubation  period, 
symptoms,  varieties,  complications,  aftereffects,  and  treatment 
of  typhoid. 

II.  (Class)  Quiz  on  lecture.  Sanitation  of  sick-room  and  hygiene 
of  patient,  family  and  nurse,  Patient's  toilet,  antipyretic 
measures,  diet,  and  general  nursing  care  in  fevers.  Prepara- 
tion for  Widal  and  anti-typhoid  serum.  Precautions  and  treat- 
ment in  hemorrhage,  perforation,  tympanites,  etc.  Quaran- 
tine and  personal  precautions 

III.  (Lecture)    Scarlet  Fever,  Measles,  German  Measles 

General  features  of  the  exanthemata.  Latest  conclusion.-, 
regarding  causes  and  methods  of  infection.  Periods  of  incuba- 
tion, immunity,  symptoms,  types  and  characteristics  of  eacli 
disease.  Complications,  after  effects,  and  treatment.  Gener.il 
precautions  and  Board  of  Health  regulations. 

IV.  Quiz  on  lecture.     General  technic  of  aseptic  nursing,  disinfec- 
tion, isolation,  etc.     Prevention  of  cross  infections.     Nursing 
care  in  above  diseases.     Special  care  of  mouth,  nose,  throat, 
eyes,  and  ears.     Precautions  as  to  rest,  warmth,  diet,  and  bath- 
ing.    Nursing    treatment    of    nephritic    complications,    otitis 
media,  endocarditis,  etc.     Charting. 

V.   (Lecture)     Small-pox,  Co>v-pox,  Chicken-pox,  and    Erysipelas 
History  of  small-pox.     Cause,  mode  of  transmission,  incuba- 
tion   period,    symptoms,    types,    stage   of  eruption,    toxemia, 
complications,  after  effects,  and  treatment  of  each    disease. 
Degree  of  quarantine  and  infectivity. 

VI.  (Class)  Quiz  on  lecture  Nursing  care  in  above  diseases  as  to 
rest,  bathing,  diet,  etc  Preparation  for  vaccination  and  dress- 
ing. Local  applications  of  cold,  antiseptics,  etc.  Irrigation  of 
eyes  and  prevention  of  pitting  in  small-pox.  Methods  of  dis- 
infection and  precautions.  Care  of  body  after  death. 
VII.  (Lecture)  Diphtheria,  Tonsillitis  and  Septic  Sore.  Throat 

History  of  diphtheria.  Causes,  sympton.s,  complications, 
after  effects,  and  treatment  of  each  disease.  Board  of  Health 
regulations. 


NURSING    IN   COMMUNICABLE    DISEASES  95 

VIII.  (Class)  Quiz  on  lecture.  Nursing  care  and  management  of 
above  diseases.  Local  throat  treatments.  Preparation  for 
giving  antitoxine,  intubation,  tracheotomy,  Schick  test. 
After-care  of  intubated  cases.  Heart  precautions.  Vincent's 
angina.  Use  of  mouth  gag  and  feeding.  Care  of  tubes — thread- 
ing, cleaning,  etc. 
IX.  (Lecture)  Influenza,  Whooping  Cough,  Mumps  and  Colds 

History,  causes,  modes  of  transmission,  symptoms,  complica- 
tions, after  effects,  treatment,  etc.  Board  of  Health  regula- 
tions. 

X.  (Class)  Quiz  on  lecture.  Nursing  care  and  management  of 
above.  Review  of  hot  and  cold  applications,  counter  irritants, 
croup-tent,  etc.  Precautions.  Technic  of  isolation  and  dis- 
infection in  a  private  home  for  more  severe  and  milder  infec- 
tions. 
XI.  (Lecture)  Cerebro-Spinal  Meningitis,  Infantile  Paralysis 

Causes,  modes  of  transmission,  infectivity,  symptoms,  com- 
plications, after  effects,  and  treatment.  Board  of  Health 
regulations. 

XII.  (Class)  Quiz  on  lecture.  Nursing  care  in  the  above  diseases. 
Importance  of  surroundings,  position  and  support.  Care  in 
convulsions.  Preparations  for  lumbar  puncture.  Precautions 
and  disinfection. 

XIII.  (Lecture)    Malaria,  Yellow  Fever,  Typhus,  Amoebic  Dysentery, 

Bubonic  Plague  and  Hook-worm 

History,  causes,  mode  of  transmission,  symptoms,  complica- 
tions, after  effects,  and  treatment.  Recent  campaigns  for 
eradication  of  malaria,  plague,  hook-worm,  etc.  Maritime 
quarantine. 

XIV.  (Class)     Quiz  on  lecture.    Nursing  care  in  above.     Baths,  diet, 
intestinal  irrigations,  and  specifics.    Measures  for  destruction 
of  insects.     Camp  sanitation. 

XV  and  XVI.  (Lecture)     Tuberculosis 

History  of  tuberculosis,  and  modern  campaign  for  prevention 
and  control.  Exciting  and  predisposing  causes,  sources  and 
modes  of  infection,  pathology,  types  and  infection,  early 
symptoms  and  course  of  disease,  complications  and  accidents, 
treatment,  Board  of  Health  regulations. 

XVII  and  VIII.  (Classes)  Quiz  on  lectures.  Nursing  care  in  tuberculosis. 
Hygiene,  rest,  diet,  and  fresh  air.  Provision  for  out-of-door 
sleeping.  Klondike  bed.  Methods  of  disinfection.  Care  of 
advanced  cases.  Technic  of  special  treatments — strapping, 
blistering,  cupping,  aspiration,  pneumothorax.  Care  in  hem- 
orrhage. Temperature  taking  and  charting.  Nurse's  'care  of 
herself. 

XIX  and  XX.  (Lectures)     Social,  Economic,  and  Educational  Factors  in  Pre- 
vention and  Treatment  of  Communicable  Diseases 
Problems  of  industry,  housing,  and  poverty  in    relation  to 
infectious  diseases,  particularly  tuberculosis.     Institution?- for 


96  OUTLINES   OF   SUBJECTS 

the  care  of  such  patients.  Education  and  care  of  patients  in 
their  hbmes.  Occupation  and  employment.  Problems  of  re- 
lief. The  out-door  clinic.  Reports  and  records.  Methods  of 
instruction.  Relation  of  immigration  to  communicable  dis- 
eases. Publicity  methods. 

NOTE — If  the  course  in  venereal  diseases  cannot  be  given 
separately,  at  least  two  lectures  in  this  subject  should  be  in- 
cluded here. 

METHODS  OF  TEACHING 

1.  The  method  advocated  is  much  the  same  as  that  followed 
in  medical  nursing. 

2.  A  visit  to  the  Board  of  Health  laboratories  would  be 
extremely  profitable  during  this  series  of  classes;  also  exhibits 
in  preventive  methods. 

3.  Experience  in  an  infectious  hospital  and  in  tuberculosis 
nursing  is  of  the  very  greatest  importance,  especially  for  all 
those  who  may  engage  in  any  form  of  Public  Health  work. 
Experience  in  the  out-patients'  department  is  also  invaluable. 

EQUIPMENT  AND  ILLUSTRATIVE  MATERIAL 

Bacteriological  slides  and  cultures,  charts,  models,  etc. 
Equipment  for  demonstration  of  all  practical  procedures. 

TEXT  AND  REFERENCE  BOOKS 

Lee:  Scientific  Features  of  Modern  Medicine. 

Paul:  Nursing  in  the  Acute  Infectious  Fevers. 

Register:  Practical  Fever  Nursing. 

Wilson:  Fever  Nursing. 

Wilcox:  A  Manual  of  Fever  Nursing. 

Emerson:  Essentials  of  Medicine. 

Roseneau:  Preventive  Medicine  and  Hygiene. 

McNutt:  Manual  for  Health  Officers. 

Knopf:  Tuberculosis  a  Curable  and  Preventable  Disease. 

Newsholme:  The  Prevention  of  Tuberculosis. 

Otis:  The  Great  White  Plague. 

Crowcll:  Tuberculosis  Dispensary  Method  and  Procedure. 

Publications  of  Boards  of  Health. 

See  also  under  Medical  Nursing,  Bacteriology  and  Public 
Sanitation. 

Nursing  in  Diseases  of  Infants  and  Children 

TIME:  20  hours — divided  as  follows: 

Lectures  or  clinics  by  pediatrician — 7  hours. 
Classes  and  demonstrations  by  nurse   (head  of  children's 
ward) — 7  hours. 


NURSING   IN   DISEASES   OF  INFANTS  AND   CHILDREN  97 

Lectures  on  social  and  psychological  topics  (special  lectures) 
— 2  hours. 

Classes  and  demonstrations  in  infant  feeding  by  nurse  or 
dietitian — 4  hours. 

The  course  to  be  given  early  in  the  second  year. 

OBJECTS  OP  THE  COURSE 

1.  To  help  nurses  to  understand  something  of  the  physical 
and  mental  development  of  normal  children  and  the  essential 
principles  of  child  hygiene  and  management,   so  they  may 
intelligently  care  for  normal  children  and  teach  others  to  care 
for  them  properly. 

2.  To  teach  them  the  principal  diseases  which  affect  children, 
what  their  special  manifestations  are,  and  how  to  adapt  nurs- 
ing measures  to  meet  the  needs  of  sick  children. 

3.  To  make  the  pupil  nurse  intelligent,  skillful  and  exact  in 
the  preparation  of  infant  feedings,  and  to  emphasize  the  im- 
portance of  proper  feeding  as  a  therapeutic  measure  in  the 
diseases  of  infancy. 

4.  To  give  a  good  sound  basis  for  later  work  in  connection 
with  milk  depots,  baby  welfare,  school-nursing  and  other  fields 
of  work  where  knowledge  and  skill  in  children's  nursing  are 
of  essential  importance. 

5.  To  give  pupils  some  appreciation  of  the  causes  and  social 
aspects   of  infant  mortality,    and  secure  their  interest   and 
cooperation  in  the  conservation  of  child  life. 

OUTLINE  OF  LECTURES  AND  CLASSES 

I.  (Lecture)     The  Physical  Development  of  the  Normal  Child  from 
Birth  to  Adolescence 

How  the  child  differs  from  the  adult.  Appearance,  weight, 
height,  muscular  development  of  organs  and  special  senses  at 
various  ages.  Normal  dentition  and  possible  complications. 
Normal  excretions.  Relation  between  physical  and  mental 
growth.  Hygiene  of  infancy  and  childhood.  Hygiene  of 
adolescent  boy  and  girl. 
II.  (Class)  Physical  Care  of  the  Normal  Infant 

Bathing,  exercise,  fresh  air,  sleep  and  clothing.    The  han- 
dling of  the  baby  and  run-about  child.     The  nursery — its  fur- 
nishings and  care.    The  daily  regime  at  different  stages.    Quali- 
fications of  a  good  children's  nurse. 
III.   (Lecture)     The  Feeding  of  Normal  Children 

Feeding  during  the  first  year.  The  very  great  importance  of 
breast  feeding  and  methods  of  encouraging  and  promoting  it. 
Artificial  feeding.  Conditions  to  be  met.  Modified  milk. 
Formulae  adapted  to  the  infant  at  various  stages.  Feeding 
of  the  premature  infant.  Diet  through  later  stages  of  child- 
hood. Food  habits. 


98  OUTLINES   OF   SUBJECTS 

IV.  (Class)  Quiz  on  above.  Position  and  care  of  infant  in  breast 
feeding.  Care  of  feedings  on  the  ward,  and  administration. 
Feeding  delicate  infants  and  run-about  children.  Making  diet 
attractive  to  older  children. 

(Classes  XVII  to  XX  to  run  parallel  if  possible.) 
V.   (Lecture)     Disorders  of  the  Digestive  Tract  in  Infancy  and  Child- 
hood 

The  sick  baby — variations  in  symptomatology  from  adults. 
Diseases  of  nutrition,  digestion  and  metabolism — marasmus, 
rachitis,  etc.  Their  causes,  symptoms,  treatment  and  con- 
valescent care.  Relation  of  diet  to  gastro-intestinal  disorders. 
(Distinguish  clearly  between  the  infant  up  to  2  years  and  over.) 
VI.  (Class)  Quiz  on  lecture.  Observation  and  description  of  symp- 
toms in  babies  and  older  children.  Difference  in  handling  and 
nursing  care  of  sick  children.  Gavage,  nasal  feeding,  lavage, 
and  enemata,  as  applied  to  small  babies  and  older  children. 
Care  of  buttocks.  Administration  of  medicines  to  children. 
Collection  and  care  of  specimens. 
VII.  Lecture)  Disorders  of  the  Respiratory  System  in  Infancy  and 

Childhood 

Bronchitis,  pneumonia  (broncho  and  lobar),  pleurisy,  empy- 
ema,  croup,  tuberculosis.  Relative  gravity  of  symptoms  in 
child  as  compared  with  adult.  Treatment  and  convalescent 
care. 

VIII.  (Class)  Quiz    on    lecture.    Observation    and    nursing    care. 
Fresh-air    treatment.    Out-door    bed     and    clothing.    Helio- 
therapy.    Croup-tent.     Preparation  for   aspiration   of    chest. 
Restraint  of  child  during  treatments. 
IX.   (Lecture)     Infectious  Diseases  in  Infancy  and  Childhood 

Susceptibility  of  children  to  infectious  diseases  and  differ- 
ences in  reaction  from  adults.  Sources  and  modes  of  infection 
in  hospital  wards.  Prevention  of  spread  of  diphtheria,  scarlet 
fever,  influenza,  common  colds,  etc.  Control  of  vaginitis  and 
isolation  of  specific  diseases  in  children's  wards.  Typhoid 
in  children.  After-effects  of  various  infections. 
X.  (Class)  Quiz  on  above.  Aseptic  precautions  in  nursing  care 
of  children,  with  special  reference  to  utensils,  thermometers, 
etc.  Care  of  special  precaution  and  isolation  cases.  Treatment 
of  infected  eyes  in  infant.  Modifications  of  other  treatments 
with  infants  and  children — baths,  packs,  hot  and  cold  applica- 
tions, etc. 
XI.  (Lecture)  Constitutional  and  Nervous  Disorders  in  Infancy  arid 

Childhood 

Principal  causes  of  nervous  disorders,  hysteria,  chorea,  epi- 
lepsy, convulsions,  "tantrums,"  etc.  Mental  defects — idiocy, 
imbecility,  cretinism  and  mutism.  Rheumatism,  nephritis, 
and  chronic  heart  diseases  in  children.  The  significance  of 
"growing  pains." 


NURSING  IN  DISEASES  OF  INFANTS  AND   CHILDREN  99 

XII.  (Class)  Quizonabove.  Observation  and  management  of  nerv- 
ous children.  Mental  hygiene.  Care  of  defective  children. 
Daily  re*gime  for  heart  cases.  Modifications  of  common  treat- 
ments— hot  pack,  mustard  bath,  cupping  and  counter  irritants, 
etc.,  for  children. 

XIII.  (Lecture)    Surgical  Conditions  in  Infancy  and  Childhood 

Congenital  and  acquired  deformities  and  malformations — 
cleft  palate,  hare-lip,  spina  bifida,  obstruction,  imperforate 
anus,  etc.  Phimosis,  circumcision,  umbilical  hernia,  intus- 
suception.  Effects  of  anaesthetics  on  children.  Early  symp- 
toms of  spinal  and  other  deformities.  Burns. 

XIV.  (Class)    Quiz  on  above.    Care  of  such  cases  before  and  after 
operation,  including  special  dressings  and  treatments.    Feed- 
ing and  restraint.     Nursing  care  of  burn  cases.     (For  care  of 
orthopedic  conditions  see  later  course.) 

XV.  (Lecture)    Social  Aspects  of  Children's  Diseases.     (By  head  of 
Social  Service  Department  or  special  lecturer.) 

The  problem  of  infant  mortality — what  it  means  to  the  com- 
munity. Causes  of  high  death  rate  in  infants.  Home  versus 
institutional  care  of  infants.  Effects  of  child  labor,  mal- 
nutrition, bad  housing,  etc.  on  vitality  and  health  of  children. 
Movements  for  conservation  of  child  life.  (An  excursion  to  a 
milk  station  or  orphanage,  day  nursery  or  foundling  home 
might  supplement  this  lecture.) 

XVI.  (Lectures)  The  Psychology  of  Childhood  (Given  by  a  teacher 
or  other  expert  in  child  psychology — should  be  introduced 
before  Lecture  XI  if  possible.) 

Mental  development  of  the  normal  child  from  birth  to  adoles- 
cence. Instincts  and  capacities  as  they  appear  in  normal 
development.  Characteristic  phases  of  development  in  boys 
and  girls.  How  to  interest  and  manage  children  at  various 
stages.  Abnormal  types.  How  to  deal  with  pernicious  habits. 
The  psychological  and  therapeutic  value  of  play.  Some  prin- 
ciples of  education.  (This  lecture  might  be  supplemented  by 
one  or  more  classes  by  a  kindergartner  dealing  with  appro- 
priate plays,  games  and  amusements  for  children,  good  pictures 
and  stories  for  children  at  different  ages,  and  the  way  of  telling 
an  interesting  story.) 

The  following  classes  in  infant  feeding  should  run  parallel 
to  topics  III  to  VI  if  possible. 
XVII.  (Class)     Utensils 

Sterilizer,  pasteurizer,  pitcher  (aluminum),  bottle  rack, 
feeding  bottles,  Chapin  dipper,  glass  funnel,  graduate,  ounce 
measuring  glass,  thermometer,  bottle  brush,  nipples,  skewer, 
etc.  Kinds  and  reasons  why  some  are  better  than  others. 
Substitutes  for  home  use — ex.  quart  dipper  for  graduate  and 
tablespoon  for  ounce  measuring  glass,  etc. 


100  OUTLINES   OF   SUBJECTS 

XVIII.   (Class)     Materials 

Lime  water —  its  composition  and  action.  Sugars — lactose, 
maltose,  dextri-maltose,  cane  sugar — their  composition  and 
action.  Milk — cows'  milk  as  compared  with  human  milk. 
Composition  of  each  and  reasons  for  modifying.  Sources  of 
supply  and  methods  of  handling  certified  milk.  Reasons  for 
using  and  Board  of  Health  regulations  governing  certified 
milk.  Pasteurized  milk, — method  of  pasteurization,  reasons 
for  pasteurizing  and  objections.  Percentage  milks — table  show- 
ing composition  of  bottled  milk  at  different  depths.  Starches 
— barley  flour,  oatmeal  flour — their  composition  and  action. 
XIX.  (Class)  Formulae 

Simple  dilution  with  boiled  water,  whole  milk,  percentage 
milk,  milk  sugar  and  lime  water.  Simple  dilution  with  cereal 
waters — rice,  oatmeal  or  barley — action  of  each.  Splitting  of 
protein  by  (1)  coagulation  of  casein  and  using  of  whey.  Con- 
stituents of  whey.  (2)  Coagulation  of  casein  and  using  of 
casein' — Eiweiss.  Fat  free  milk.  Predigested  foods.  Pepsin 
or  pancreatin  extract.  Patent  foods — their  objections  and 
uses.  Malt  soup  mixtures.  Use  of  strained  cereals,  broths  and 
vegetable  soups  in  infant  feeding. 
XX.  (Class)  Technic 

Care  of  hands.  Care  of  milk  after  delivery.  Care  of  milk 
after  modifying.  Care  of  utensils — to  be  used  only  for  formu- 
lae— to  be  thoroughly  washed  and  sterilized.  Care  of  nipples 
and  bottles.  Accuracy  in  measurements.  Preparation  of 
feedings — bottles  filled  with  exact  amount  required  for  feed- 
ings. Sealing  with  sterile  cotton  handled  with  forceps  or  patent 
caps.  Method  of  labelling  for  hospital  use.  Method  of  apply- 
ing nipples. 

METHODS  OF  TEACHING 

1.  Follow  the  general  method  outlined  under  medical  nursing. 
The  clinical  method  is  infinitely  superior  to  the  simple  lecture, 
and  should  be  adopted  in  this  subject  if  at  all  possible.     Every 
opportunity  should  be  taken  to  have  pupils  observe  and  handle 
actual  cases. 

2.  Practical  experience  in  the  care  of  children  is  of  paramount 
and  increasing  importance  for  every  nurse.     Such  experience 
should  include  the  care  of  very  young  children  as  well  as  those 
of  later  years,  and  in  medical  and  feeding  cases  as  well  as  surgi- 
cal and  orthopedic  cases.     Dispensary  experience  in  the  chil- 
dren's clinic  is  also  invaluable,  especially  for  those  who  expect 
to  go  into  school  or  milk  station  work  or  any  form  of  Public 
Health  work. 

3.  The  nursing  procedures  as  applied  in  the  children's  ward 
are  so  different  in  many  respects  from  the  methods  employed 
in  adult  wards,  that  it  will  be  necessary  to  discuss  those  modi- 


GYNECOLOGICAL  NURSING  101 

fications  and  adaptations  in  detail  and  to  demonstrate  them  for 
pupils.  These  demonstrations  can  be  given  in  the  ward  or  in 
the  demonstration-room. 

4.  Work  in  this  course  should  be  correlated  closely  with 
courses  in  general  medical  and  surgical  nursing,  dietetics,  or- 
thopedics, etc. 

5.  The  classes  in  infant  feeding  should  be  held  in  the  diet 
kitchen  or  milk  laboratory  where  all  the  materials  and  utensils 
can  be  seen  and  demonstrated.     In  the  limited  time  assigned, 
no  individual  laboratory  work  could  probably  be  covered,  but 
each  student  should  have  a  period  of  practical  experience  in  the 
milk-room  in  connection  with  her  training  in  the  children's 
wards. 

ILLUSTRATIVE  MATERIAL  AND  EQUIPMENT 

Charts,  models,  pictures,  utensils  and  materials  for  infant 
feeding,  food-charts,  etc. 

TEXT  AND  REFERENCE  BOOKS 

McCombs:  Diseases  of  Children  for  Nurses. 

Ramsay:  Care  and  Feeding  of  Infants  and  Children. 

Holt:  Diseases  of  Infancy  and  Childhood. 

Holt:  The  Care  and  Feeding  of  Children. 

Chapin  and  Pisek:  Diseases  of  Infants  and  Children. 

Brown :  The  Baby. 

Grulee:  Infant  Feeding. 

Morse:  Care  and  Feeding  of  Children. 

Morse  and  Talbot:  Diseases  of  Nutrition  and  Infant  Feeding. 

Kerley:  Practice  of  Pediatrics. 

Kerley:  Short  Talks  to  Young  Mothers. 

Starr:  Hygiene  of  the  Nursery. 

West:  Care  of  Children  and  Prenatal  Care — Pamphlets  from 

Children's  Bureau,  Washington,  D.  C. 
Rose:  Feeding  the  Family. 
Smith:  Baby's  First  Two  Years. 
Kirkpatrick:  Child  Study. 
Kirkpatrick:  Individual  in  the  Making. 
Amusements    for    Convalescent    Children — from    New    York 

State  Board  of  Health. 
American  Journal  Diseases  of  Children. 
American  Journal  for  Care  of  Cripples. 

See  also  under  Special  Therapeutics,  Orthopedic  Nursing 
Obstetrical  Nursing,  etc. 

Gynecological  Nursing  and  Diseases  of  the  Male  Genito-Urinary  Tract 
TIME  :  10  hours — divided  as  follows — 

Lectures  or  clinics  by  physician  specialist  in  gynecology  and 
genito-urinary  diseases — 5  hours.    Quizzes,  classes  and  demon- 


102  OUTLINES   OF  SUBJECTS 

strations  conducted  by  the  head  nurse  of  the  gynecological 
ward — 5  hours.     Course  to  be  given  in  the  Second  Year. 

OBJECTS  OF  COURSE 

1.  It  is  intended,  through  the  lectures,  to  give  the  student  an 
intelligent  understanding  of  the  diseases  of  the  genito-urinary 
tract,  and  the  various  forms  of  operative  treatment  for  surgical 
conditions  of  the  tract. 

2.  The  classes  and  demonstrations  are  for  the  purpose  of 
enabling  the  student  to  become  more  familiar  with  the  partic- 
ular nursing  procedures  in  this  branch  of  work. 

OUTLINE  OF  LECTURES  AND  CLASSES 
I.  (Lecture)    Introduction 

Brief  history  of  gynecology  as  a  specialty.  Anatomy  and 
physiology  of  the  reproductive  organs  in  review.  Menstrual 
and  reproductive  functions  of  organs.  Puberty  and  the  meno- 
pause. Sterility  and  its  causes.  Abnormal  menstruation- 
causes  and  treatment.  Menstrual  hygiene. 

II.  (Class)  Quiz  on  anatomy  and  physiology  of  pelvic  organs. 
Review  on  surgical  materials  especially  those  used  in  gyne- 
cological and  G.  U.  dressings  and  treatments.  Equipment  and 
care  of  the  dressing-rooms  for  gynecological  and  genito-urinary 
cases.  Nurses'  relation  to  educational  and  ethical  problems 
arising  from  this  special  type  of  work. 

III.  (Lecture)     Diseases  of  the  Reproductive  Tract 

Sources  of  infection,  symptoms,  treatment.  Relation  of 
venereal  disease  to  infection.  Displacement  of  organs.  Mal- 
formations. Tumors  of  the  pelvic  organs,  benign  and  malig- 
nant. Early  symptoms  and  cancer.  Importance  of  early  diag- 
nosis and  treatment.  Tumor  complications. 

IV.  (Class)    Quiz  on  causes,  treatment  and  nursing  care  in  above 
conditions.    Reception  of  patient.    Observation  of  symptoms. 
Importance  of  mental  attitude  of  patient.     Review  of  gyne- 
cological   treatments — douches,    catherization,    etc.     Nurse's 
responsibility   in   the   early   diagnosis   of   malignant  tumors. 
Opportunities  for  educational  work  in  the  prevention  of  cancer. 

V.   (Lecture)     Diseases  of  the  Urinary  Tract 

Malformations,  foreign  bodies,  infections,  fistulae,  tumors, 
stricture,  calculi  and  diseases  of  the  external  genitalia.  Ex- 
aminations, treatments  and  operative  measures  used  in  above 
conditions. 

VI.  (Class)    Preparation    for    examinations — abdominal,    pelvic, 
cystoscopic.    Discussion   of   nursing   care   and   technique   in 
relation  to  important  treatments.     Nursing  care  of  drainage 
cases. 
VII.  (Lecture)     Gynecological  Operations 

The  various  postures,  and  instruments  used.  Protection  of 
patient.  Assistance  to  physician.  Preparation  for  operation 


ORTHOPEDIC  NURSING  103 

—  the  skin  —  the  digestive  tract.  The  main  types  of  minor 
operations  and  the  nursing  measures  required  to  insure  success- 
ful results. 

VIII.  (Class)  Quizron  major  and  minor  operations  and  vocabulary 
in  connection.  Preparation  of  patient  for  operation,  local 
and  general.  Importance  of  comfortable  positions  during 
operation  and  in  post-operative  care.  Care  of  skin  and  binder. 
Importance  of  air  and  nourishment.  Drugs  used  in  treatment. 
Dressings  in  each  type  of  operation. 
IX.  (Lecture)  Gynecological  Operations 

Vocabulary.  Major  operations,  including  those  for  mal- 
formations and  displacements.  Injuries.  Inflammatory  con- 
ditions and  new  growths.  Post-operative  treatment  and  com- 
plications. Post-operative  care  of  patient. 

X.  (Class)  Observation  of  first  symptoms  after  operation. 
Methods  of  preventing  and  meeting  complications  and  emer- 
gencies —  shock,  hemorrhage,  infected  stitches,  retention  of 
urine,  burns  by  heat,  iodine,  anesthetic  or  acid,  phlebitis,  etc. 

METHODS  OF  TEACHING 

The  general  plan  to  be  followed  is  outlined  under  Surgical 
Nursing. 


EQUIPMENT  AND  iLi/csTRATiyE  MATERIAL 

Bony  pelvis  of  skeleton,  muscular  pelvis  of  mannikin  with 
organs  in  position  ;  pathological  specimens  of  tract  from  labora- 
tory. 

TEXT  AND  REFERENCE  BOOKS 

Parker  and  Breckinridge  :  Surgical  and  Gynecological  Nursing. 

Cragin:  Essentials  of  Gynecology. 

Kelly:  Medical  Gynecology. 

Kelly:  Operative  Gynecology. 

Davis:  Obstetric  and  Gynecologic  Nursing. 

MacFarlane:  Gynecology  for  Nurses. 

See  also  books  under  Anatomy  and  Physiology,  Obstetrics, 
Hygiene  and  Venereal  Diseases,  etc. 

Orthopedic  Nursing 

TIKE  :  10  hours  divided  as  follows  :  — 

Lectures  or  clinics  by  orthopedic  specialist'  —  4  hours. 

Classes  and  demonstrations  by  a  nurse  with  special  training 
in  orthopedic  work—  5  hours. 

Lecture  on  social  aspects  of  orthopedic  work  by  head  of  social 
service  department'  —  1  hour.  Given  in  the  later  part  of  the  sec- 
ond year. 


104  OUTLINES   OF   SUBJECTS 

OBJECTS  OF  THE  COURSE 

1.  To  give  the  nurse  a  definite  idea  of  orthopedic  nursing  as 
distinct  from  general  surgical  nursing,  with  a  knowledge  and 
practice  in  the  use  of  various  splints  and  apparatus  peculiar  to 
orthopedic  work. 

2.  To  teach  her  the  cause  and  prevention  as  well  as  the  care 
of  orthopedic  conditions,  and  the  subsequent  needs  of  the  indi- 
vidual resulting  from  what  at  best  is  generally  a  long  contin- 
ued illness,  whether  it  be  chronic  or  acute. 

3.  To  give  her  a  better  understanding  of  certain  educational 
and  social  problems  concerning  the  physically  deficient  children 
in  our  schools,  and  a  keener  interest  in  public  health  and  tuber- 
culosis work. 

OUTLINE  OF  LECTURES  AND  CLASSES 

I.  (Lecture)     Orthopedic  Conditions  Due  to  Tuberculosis 

Anatomy  and  histology  of  bone.  Deformities  due  to  tubenju- 
losis  and  the  care  and  treatment  of  the  same.  General  hygiene. 
Congenital  malformations  and  deformities.  Dislocations, 
club  feet,  etc. 

II.  (Class)  Orthopedic  apparatus- — frames,  traction  splints, 
Thomas  splint,  caliper  splints,  braces,  strappings  (adhesive), 
etc.  Practice  in  the  application  of  apparatus,  frames  and  ex- 
tensions. Bed  making,  bathing  and  general  nursing  care  for 
such  patients. 

III.  (Lecture)     Diseases  Due  to  Faulty  Nutrition 

Causes,  symptoms  and  treatment  of  rickets,  bow  legs,  breech 
knees,  etc.  Prevention.  Dietetic  and  hygienic  care. 

IV.  (Class)     Quiz  on  lecture.     Practice  in  application  of  appara- 
tus— splints,  adhesive  strappings,  for  flat  foot  and  other  strains. 

V.  (Lecture)     Deformities  of  the  Spine 

Causes,  symptoms,  and  treatment  of  Pott's  disease,  curva- 
tures, etc.     Orthopedic  exercises  and  corrective  work. 
VI.   (Class)     Quiz  on  lecture.     Practice  in  general  exercises  and 
special  gymnastic  work.     Special  scoliosis  clinics.     Possibility 
of  home  treatment. 
VII.   (Lecture)     Infantile    Paralysis.     Spastic  and  other  paralyses. 

After-care.     Muscle-training.     Splints  and  other  appliances. 
VIII.  (Class)     Quiz  on  lecture.     Use  of  the  plaster-of-paris  bandage. 

Practice  in  making  and  applying. 
IX.   (Lecture)     Social  Problems  Connected  urith  Orthopedic  Work. 

Special  problems  of  education  and  training  of  physically 
handicapped.  Employment  for  cripples.  Special  schools  and 
institutions  for  crippled  children.  Work  of  the  school  nurse 
and  visiting  nurse  in  discovering  and  dealing  with  orthopedic 
cases.  Cooperation  with  social  and  educational  agencifes. 
X.  (Class)  Practice  in  the  making  and  application  of  the  plaster- 
of-paris  bandage. 


OBSTETKICAL  NURSING  105 

METHOD  OF  TEACHING 

1.  The  method  of  teaching  is  by  lecture,  demonstration,  reci- 
tation and  practice,  all  lectures  and  demonsrations  being  illus- 
trated by  clinical  material  from  the  wards.    An  effort  should  be 
made  throughout  to  emphasize  the  nursing  side  of  the  various 
problems  presented. 

2.  It  is  particularly  rlecesssary  that  the  nurse  have  ample 
practice  in  the  handling  of  apparatus,  and  the  actual  applica- 
tion of  splints,  frames,  plaster  and  the  like,  under  careful  super- 
vision, before  she  be  allowed  to  do  the  work  for  the  patient. 
It  is  presupposed  that  she  shall  already  have  been  well  in- 
structed in  bandaging,  massage  and  general  surgical  technique. 
To  be  complete  her  ward  experience  should  be  supplemented 
by  outside  visiting  or  dispensary  work,  where  she_may  learn  the 
end  results  which  in  such  long  cases  do  not  come  to  her  atten- 
tion in  the  hospital  wards. 

3.  This  course  should  be  correlated  closely  with  courses  in 
surgical  nursing,  in  diseases  of  children  and  massage. 

EQUIPMENT  AND  ILLUSTRATIVE  MATERIAL 

Plaster  bandages  and  materials  for  making  Bradford  frames, 
traction,  Thomas  and  caliper  splints,  braces  for  breech  knees, 
bow  legs,  curvature  of  the  spine,  etc.  Adhesive  plaster,  plas- 
ter models,  charts  and  photographs  illustrating  deformities. 

TEXT  AND  REFERENCE  BOOKS 

Berry:  Orthopedic  Surgery  for  Nurses. 

Thorndike:  Orthopedic  Surgery. 

Bradford  and  Lovett :  Treatise  on  Orthopedic  Surgery. 

Tubby:  Deformities — including   diseases   of  the    Bones    and 

Joints. 

See  also  Surgical  Nursing,  Nursing  in  Diseases  of  Infants  and 
Children,  etc. 

Obstetrical  Nursing 

TIME  :  20  hours  divided  as  follows : — 

Lectures  and  clinics  by  obstetrician' — 10  hours. 
Classes  and  demonstrations  by  nurse  (head  of  obstetrical 
ward  preferably) — 9  hours. 

Lecture  on  social  aspects  of  obstetrics  by  social  service  nurse 
— 1  hour. 

OBJECTS  OF  COURSE 

1.  To  make  nurses  intelligent  and  competent  in  the  nursing 
care  of  obstetrical  cases,  both  normal  and  abnormal,  and  in  the 
care  of  small  babies. 

2.  To  enable  the  nurse  to  advise  and  instruct  mothers  in  the 
care  of  their  own  health  both  before  and  after  child-birth,  and 
in  the. conditions  necessary  for  the  rearing  of  healthy  children. 


106  OUTLINES   OF  SUBJECTS 

3.  To  arouse  an  interest  in  obstetrical  nursing  and  a  keener 
appreciation  of  its  importance,  not  only  to  individual  mothers 
and  babies,  but  to  the  welfare  of  the  race. 

4.  To  arouse  an  interest  in  the  social  aspects  of  obstetrical 
work  and  to  develop  a  wholesome  and  helpful  attitude  toward 
such  sex  problems  as  the  nurse  meets  in  connection  with  her 
work. 

5.  To  establish  a  definite  connection  between  previous  work 
in  surgical  technic  and  obstetrics. 

OUTLINE  OF  CLASSES  AND  LECTURES 

I.  (Lecture)     Introduction 

Brief  history  of  obstetrics.  The  place  of  obstetrics  in  medi- 
cine. Responsibilities  and  opportunities  of  obstetricians  and 
nurses.  Anatomy  of  female  pelvis.  Landmarks.  Varieties  of 
pelvis  and  their  relation  to  position  and  presentation.  Abnor- 
malities and  their  relation  to  child-birth.  Review  of  female 
organs  of  generation. 

II.  (Class)  Brief  quiz  on  anatomy  of  reproductive  system.  Out- 
line of  reproduction  in  lower  animals,  beginning  with  one-celled 
animals  and  using  the  chick,  the  frog,  and  the  rabbit  or  cat  as 
types.  (See  Marshall's  Embryology,  or  Bigelow's  Applied 
Biology.) 

III.  (Lecture)     Physiological  Pregnancy 

Ovulation,  menstruation  and  impregnation.  The  phenomena 
of  pregnancy  and  segmentation.  Nourishment  of  fetus1 — size 
and  weight  at  different  stages.  Circulation.  Conditions  neces- 
sary for  normal  development.  The  facts  about  "maternal  im- 
pressions." Influence  and  determining  factors  in  heredity. 
The  purpose  and  scope  of  eugenics. 

IV.  (Class)     Quiz  on  lecture.     The  mother's  preparation  for  her- 
self as  to  clothing,  dressings,  utensils,  etc.    The   "layette." 
Newer  ideals  as  to  babies'  clothing.     Simplicity  and  economy 
emphasized.    The  baby's  cot  or  basket. 

V.  (Lecture)  Changes  in  the  Maternal  Organism  During  Pregnancy 
Signs  and  symptoms  of  pregnancy — presumptive,  probable, 
And  positive.     Duration.     Methods  of  reckoning  date  of  termi- 
nation.    Hygiene  and  management  of  pregnancy. 
VI.  (Class)     Quiz  on  lecture.     Pre-natal  care.     How  to  advise  and 
help  the  mother  as  to  employment,  reading,  diversions,  cloth- 
ing, diet,  etc.     Importance  of  mental  attitude.     Problems  in 
calculation  of  dates.     Make  out  suggestive  diets.     Routine  ex- 
amination of  urine  in  pregnancy.    The  nurse's  obstetrical  outfit. 
VII.   (Lecture)     Disorders  and  Diseases  nf  Pregnancy 

Nausea,  pernicious  vomiting,  varicose  veins,  oedema,  anemia, 
neuralgia,  eclampsia,  ectopic  gestation,  placenta  praevia,  abor- 
tion, and  miscarriage.  Causes,  symptoms,  and  treatment. 


OBSTETRICAL  NURSING  107 

VIII.  (Class)    Quiz  on  lecture.     Nursing  care  in  above  conditions. 
Drill  on  obstetrical  terms.     Instruments  and  equipment  of  de- 
livery-room.   Making  of  bed  for  obstetrical  case.    Rules  for 
admission  of  obstetrical  patients  in  the  hospital. 
IX.  (Lecture)    Mechanism  and  Conduct  of  Normal  Labor 

Theories  concerning  cause  of  labor.  Obstetrical  ether.  Ni- 
trous oxide  or  American  ' '  Twilight  Sleep . ' '  Signs  of  labor — the 
three  stages.  Presentations.  Management  of  each  stage. 
Immediate  care  of  mother  and  infant. 

X.  (Class)    Quiz  on  lecture.    Preparation  of  delivery-room.    Prep- 
aration of  patient.     Technic  of  nursing  care  and  assistance  to 
physician  at  each  stage  of  labor.    Duties  of  nurse  in  absence  of 
physician. 
XI.  (Lecture)    Operative  Delivery 

Forceps  delivery,  breech  delivery,  Caesarian  section  and  de- 
structive operations.  Methods  of  inducing  premature  labor. 
Requirements  for  repair  of  lacerations. 

XII.  (Class)  Quiz  on  lecture.  Preparation  for  various  operative 
measures,  and  nursing  care  of  patient  before,  during  and  after 
each.  Care  of  perineal  stitches. 

XIII.  (Lecture)    Accidents  and  Complications 

Symptoms  and  treatment  of  post-partum  and  intra-partum 
haemorrhage,  eclampsia,  heart-failure,  retained  placenta,  etc. 
Accidents  and  injuries  to  the  new-born — asphyxia,  haemor- 
rhage, traumatisms,  infections,  etc. 

XIV.  (Class)    Quiz  on  lecture.    Nursing  care  of  patient  in  above 
conditions.     Preparation  for  uterine  packing,  saline  infusions, 
hot  packs,  etc.    The  care  of  the  baby — dressing  of  cord,  care  of 
the  eyes,  etc.    First  care  of  the  premature  baby — jacket  and 
cot,  feeding,  resuscitation  and  use  of  lung  motor. 

XV.   (Lecture)     The  Puerperium 

Anatomical  changes  in  uterus,  cervix,  vagina,  and  abdominal 
walls.    Symptoms  to  be  observed  and  reported.    Special  at- 
tention to  lochia.    Care  of  breasts  and  encouragement  of  breast 
feeding.    Contra-indications  for  breast-feeding. 
XVI.  (Class)    Quiz  on  lecture.    The  routine  nursing  care  of  normal 
cases — position,  bathing,  diet,  application  of  breast  and  ab- 
dominal binders  and  perineal  dressings.    Use  of  breast  pump. 
Massage  of  breast.    Local  applications  for  nipples  and  breasts. 
The  obstetrical  chart.    Catheterization  of  puerperal  patient. 
XVII.   (Lecture)     Pathological  Puerperium 

Puerperal  septicaemia,  phlegmasia  dolens,  mastitis,  puerperal 
insanity,  urinary  and  intestinal  disturbances,  etc.  Causes, 
symptoms,  treatment,  and  general  care. 

XVIII.  (Class)  Quiz  on  lecture.  Nursing  care  of  above  cases  and 
special  treatments  reviewed.  Preparations  for  intra-uterine 
douche.  Dressing  for  incision  of  breast.  Precautions  and 
treatment  in  puerperal  insanity. 


108  OUTLINES   OF  SUBJECTS 

XIX.  (Lecture)    Social  Aspects  of  Obstetrical  Nursing 

The  older  and  newer  attitude  toward  child-birth.  Social 
problems  arising  in  obstetrical  work.  The  unmarried  mother. 
The  child  mother.  Relation  of  industry  to  child-birth.  Res- 
cue homes  and  foundling  institutions.  Infanticide  and  abor- 
tion. Blindness  of  the  new-born.  The  problem  of  birth  con- 
trol. Reasons  for  and  against  the  teaching  of  birth-control. 
Legislation  governing  in  this  and  other  countries.  The  midwife 
problem.  The  nurse's  influence  and  responsibility  in  such 
problems. 

XX.  Observation  lesson  or  clinic  to  be  introduced  wherever  it  will 
be  most  helpful — preferably  in  small  groups.  Attendance 
throughout  one  case  of  labor  with  full  report  of  the  case. 

METHODS  OF  TEACHING 

1.  The  clinical  method  should  be  used  as  far  as   possible. 
All  specially  interesting  cases  should  be  seen  by  nurses.    As 
many  procedures  as  possible  should  be  demonstrated  in  the  de- 
livery room. 

2.  The  nurse  should  have  her  operating  room  training  before 
she  has  her  practical  work  in  obstetrics.     If  these  lectures  and 
classes  can  not  run  parallel  with  the  practical  training  it  is 
better  for  them  to  come  first.     The  practical  experience  is  of 
very  great  importance  and  it  should  be  as  full  and  complete  as 
possible.    Out-patient  work  is  not  very  profitable  unless  care- 
fully supervised  by  a  teaching  graduate  nurse. 

3.  Correlate  course  in  obstetrics  closely  with  courses  in  bac- 
teriology, gynecological  nursing,  surgical  nursing,  and  nursing, 
of  infants  and  children. 

ILLUSTRATIVE  MATERIAL  AND  EQUIPMENT 

Skeleton,  separate  pelvis,  model  of  baby  and  placenta. 
Laboratory  specimens  of  embryo  and  fetus  at  various  stages. 
Lantern  slides  illustrating  reproduction. 

TEXT  AND  REFERENCE  BOOKS 

De  Lee:  Obstetrics  for  Nurses. 

Cooke:  A  Nurse's  Handbook  of  Obstetrics. 

Williams:  Obstetrics. 

Polak:  Obstetrics. 

Marshall:  Vertebrate  Embryology. 

Bigelow:  Applied  Biology. 

Siemens:  Prospecive  Mother. 

Latimer:  Girl  and  Woman. 

Prenatal  pamphlet  published  by  Federal  Children's  Bureau. 

Pamphlet  on  Midwives  published  by  Committee  on  Blindness 

of  State  Charities  Aid,  N.  Y. 

See  also  under  Diseases  of  Infants  and  Children,  Venereal 
Diseases,  etc. 


NURSING  IN  DISEASES  OF  THE  EYE,  EAR,  NOSE  AND  THROAT      109 

Nursing  in  Diseases  of  the  Eye,  Ear,  Nose  and  Throat 

TIME:  10  hours,  divided  as  follows: 

Medical  lectures  and  clinics  given  by  specialists — 5  hours. 

Nursing  classes  and  demonstrations  given  by  nurse  specially 
qualified  in  E.  E.  N.  and  T.  work' — 4  hours. 

Lecture  on  social  aspects  given  by  head  of  social  service  de- 
partment or  other  qualified  person — 1  hour.  This  course  to  be 
given  in  the  latter  half  of  the  second  year  preferably. 

OBJECTS  OF  COURSE 

1.  To  give  nurses  an  understanding  of  the  care  and  treatment 
of  the  eye,  ear,  nose  and  throat  in  normal  and  abnormal  condi- 
tions. 

2.  To  enable  them  to  safely  and  efficiently  care  for  patients 
with  diseases  of  these  organs. 

3.  To  arouse  an  interest  in  this  branch  of  nursing  which  will 
lead  nurses  into  this  field  equipped  with  a  basis  for  further 
specialization,  and  for  preventive  and  educational  work. 

OUTLINE  OP  CLASSES  AND  LECTURES 

I.  (Lecture)    Diseases  of  the  Eye 

Review  of  the  anatomy  and  physiology  of  the  eye.  Eye 
strain — prevention  and  effects.  Injuries  of  the  eye.  Diseases 
of  the  lids,  lacrymal  apparatus  and  conjunctiva.  Corneal  ul- 
cer, keratitis,  iritis,  glaucoma,  cataract,  gonorrheal  ophthal- 
mia, opthalmia  neonatorum,  and  trachoma.  Causes,  symp- 
toms and  treatment  of  these.  Usual  operative  procedures. 
II.  (Class)  Quiz  on  lecture.  Assisting  with  examinations  of  the 
eye.  Solutions  used  in  treatment,' — effects,  preparation,  care. 
Demonstrations  of  hot  and  cold  eye  applications,  the  eye  irri- 
gation, the  preparation  for  dressings.  Preparation  of  patient 
for  operation  and  after  care.  Nurse's  duties  in  cases  of  injuries 
or  foreign  bodies.  Precautions  in  care  of  patient  suffering 
from  communicable  eye  disease. 

III.  (Lecture)    Diseases  of  Mouth,  Pharynx  and  Larynx 

Review  of  anatomy  and  physiology.  Diseases  of  the  teeth 
and  gums — pyorrhea,  abscesses,  etc.  Effect  on  health.  Hy- 
giene of  mouth  and  teeth.  Operative  procedure  for  correctioto 
of  deformities  of  teeth  and  jaws.  Diseases  of  the  tonsils  and 
adenoids — causes,  effects,  symptoms,  treatment  and  operative 
procedures.  Diseases  of  larynx.  Tumors,  benign  and  malig- 
nant. Causes,  effects,  symptoms,  treatment  and  operative 
procedures. 

IV.  (Class)    Quiz  on  lecture.     Nurse's  duties  in  connection  with 
oral  hygiene.    Assisting  with  examinations  of  mouth,  pharynx, 
and  larynx.    Applying  medication.    Gargles,  irrigations,  in- 


110  OUTLINES   OF  SUBJECTS 

halations,  etc.,  reviewed.    Preparation  of  patient  for  operation 
and  after  care  in  case  of  tonsillectomy,  laryngectomy,  trache- 
otomy, etc.     Control  of  hemorrhage. 
V.  (Lecture)     Diseases  of  the  Ear 

Review  of  anatomy  and  physiology  of  the  ear.  Examination 
of  ear.  Deafness — its  causes  and  prevention.  Common  tests 
of  hearing.  Diseases  of  the  auricle  and  external  ear  (foreign 
bodies,  eczema,  furunculosis,  impacted  cerumen,  etc.).  Dis- 
eases of  the  middle  ear — chronic  and  acute  otitis  media,  mas- 
toiditis,  etc.  Complications — cerebral  abscess,  meningitis, 
sinus,  thrombosis,  etc. — causes,  symptoms  and  treatment, 
operative  and  non-operative. 

VI.  (Class)  Quiz  on  lecture.  Advice  nurses  may  give  concerning 
foreign  bodies,  chronic  discharging  ears,  etc.  Demonstration 
of  hot  and  cold  applications.  The  ear  irrigation.  Preparation 
for  myringotomy  and  incision  of  furuncle.  Preparation  of  pa- 
tient for  mastoid  operation  and  post-operative  care.  Dress- 
ings, instruments  and  supplies  used.  Symptoms  and  signs  of 
complications.  Xursing  care  of  patients  with  cerebral  abscess, 
meningitis,  thrombosis. 
VII.  (Lecture)  Diseases  of  the  Nose  and  Accessory  Sinuses 

Review  of  anatomy  and  physiology.  Diseases  of  the  nasal 
tract,  including  acute  and  chronic  rhinitis  and  deflections  of 
the  septum' — their  causes,  symptoms  and  effect  on  general 
health.  Methods  of  examination  and  treatment,  operative 
and  non-operative.  Infections  of  the  sinuses.  Mechanism  of 
infections — their  causes,  symptoms  and  effect  on  health 
Methods  of  examination  and  treatment. 

VIII.  (Class)  Quiz  on  lecture,  assisting  with  examination  of  the 
nose  and  sinuses.  Demonstration  of  nasal  irrigation  and  nasal 
spray.  Control  of  nasal  hemorrhages.  Care  of  patient  after 
nasal  operations.  The  preparation  of  patient  and  apparatus 
for  opening  and  irrigating  the  sinuses. 

IX.  (Lecture  or  clinic)     The  Observation  of  Early  Symptoms  and 
Marked  Abnormalitise 

How  to  recognize  early  signs  of  eye,  ear,  nose  and  throat 
trouble.     Simple  routine  tests  of  vision  and  hearing  for  school 
nurses.     Examination  of  the  mouth  for  adenoids,  enlarged  ton- 
sils, and  defective  teeth.     Assistance  in  dispensary  treatment. 
(This  lesson  should  be  held  in  the  dispensary  or  children's  clinic 
and  pupils  should  have  an  opportunity  to  observe  cases  them- 
selves and  try  to  identify  the  commoner  abnormal  conditions.) 
X.   (Lecture)     Social  Aspects  of  Diseases  of  the  Eye,  Ear,  Nose  and 
Throat 

Social  importance  of  defects  and  diseases  of  the  special 
senses.  Relation  todefectiveness,  dependency,  unemployment, 
etc.  Social  causes  of  blindness — industrial  accidents,  venereal 
diseases,  the  midwife  problem. etc.  OrganizM  troverr.cnt"  for 


NURSING  IN   MENTAL  AND   NERVOUS   DISEASES  111 

the  prevention  of  blindness.  Legislation,  research  and  pub- 
licity. Institutional  care  of  the  blind  and  deaf.  Relation  of 
adenoids,  tonsils  and  teeth  defects  to  education  and  delin- 
quency. Special  applications  to  the  work  of  the  school  nurse 
and  general  public  health  work. 

METHODS  OP  TEACHING 

The  clinical  method  should  be  used  as  much  as  possible.  A 
term  of  service  in  the  out-patient  department  will  usually  pro- 
vide good  experience  in  this  line  of  work.  The  general  operat- 
ing room  training  should  precede  the  course. 

EQUIPMENT  AND  ILLUSTRATIVE  MATERIAL 

Skeleton  and  separate  head.  Models  of  eye  and  ear.  Charts. 
All  materials  needed  for  practical  demonstrations. 

TEXT  AND  REFERENCE  BOOKS 

Emerson:  Essentials  of  Medicine. 

Bacon:  Manual  of  Otology. 

May:  Diseases  of  the  Eye. 

Manhattan  E.  E.  and  T.  Hosp. :  Nursing  in  Diseases  of  the  Eye, 

Ear,  Nose  and  Throat. 
Pamphlets  published  by  the  New  York  State  Committee  for 

the  Prevention  of  Blindness. 

See  also  under  Anatomy  and  Physiology,  Bacteriology  and 
Modern  Social  Problems. 

Nursing  in  Mental  and  Nervous  Diseases 

TIME  :  20  hours  divided  as  follows : 

Lectures  and  clinics  by  physician  (neurologist  or  psychia- 
trist), 10  hours. 

Classes  and  demonstrations  by  nurse  instructor  with  special 
training,  9  hours. 

Lecture  on  social  aspects  by  head  of  social  service  department 
or  a  specialist  in  mental  hygiene,  1  hour. 

Course  to  be  given  in  early  part  of  third  year. 

OBJECTS  OF  THE  COURSE 

1.  To  teach  the  student  nurse  the  relationship  between  men- 
tal and  physical  illness  and  the  application  of  general  nursing 
principles  to  mental  nursing. 

2.  To  teach  the  underlying  causes  of  mental  disease  with 
modern  methods  of  treatment  available  both  in  the  hospital 
and  in  the  community,  and  to  endeavor  to  overcome  the  stigma 
attached  to  mental  illness  or  mental  hospital  care. 

3.  To  train  the  nurse  in  observation  of  symptoms  as  expressed 
in  early  childhood  and  in  later  life  through  the  behavior  of 
patients,  so  that  the  early  signs  of  mental  illness  may  be  under- 


112  OUTLINES  OF  SUBJECTS 

stood  and  appreciated,  and  so  that  nurses  may  give  active  and 
intelligent  cooperation  in  movements  for  the  prevention  of 
mental  illness. 

4.  To  teach  the  importance  of  directed  habits  of  thought,  de- 
sirable associations  and  proper  environmental  conditions  in 
early  childhood  and  to  show  the  relationship  of  make-up  to 
mental  disorders. 

5.  To  assist  in  developing  resourcefulness,  versatility,  adapt- 
ability and  individuality  in  the  nurse.     To  emphasize  quali- 
ties essential  to  success  in  mental  work  and  the  importance  of 
special  training  in  this  branch  of  nursing. 

OUTLINE  OF  LECTURES  AND  CLASSES 

I.   (Lecture)     Introduction 

Anatomy  and  physiology   of    the   central  nervous  system. 
Biological  introduction.     Sympathetic  system  and  function. 
II.  (Class)    Quiz' — Anatomy  and  physiology  of  the  nervous  system. 

III.  (Lecture)     Neurology 

Disorders  of  the  cord:  tumors,  myelitis,  poliomyelitis,  tabes, 
syringomyelia,  sclerosis,  atrophies,  paralysis  agitans,  chorea, 
tics,  tetany. 

IV.  (Class)     Summary  of  care  of  mental  patients  in  hospitals  with 
present-day  developments.    The  mental  hygiene  movement. 
The  admission  of  patients.     Commitment  procedures  and  pa- 
role.    Indications  and  contra-indications  for  restraint  meth- 
ods of  treatment.     Personal  qualifications  and  educational  re- 
sources desirable  for  the  nurse  in  mental  work. 

V.  (Lecture)     Neurological   Conditions   Associated  with  Abnormal 

Mental  States 

Epilepsy,  traumatic  psychosis,  brain  tumor  and  brain  ab- 
scess, arterio-sclerosis  of  brain,  aphasia,  paralysis. 
VI.  (Class)  General  principles  governing  care  of  mental  and  nerv- 
ous patients.  The  application  of  nursing  procedures  in  neu- 
rological conditions  with  special  emphasis  on  care  of  skin  and 
the  care  of  patients  in  convulsions.  The  effect  of  environment, 
diet,  exercise,  massage,  electric  treatment,  etc.  The  observa- 
tion of  symptoms  as  indicated  in  behavior.  The  necessity  for 
accurate  record  keeping  of  what  actually  occurs,  not  simply 
impressions  received.  The  importance  of  noting  all  physical 
symptoms  as  well  as  mental. 
VII.  (Lecture)  Organic  Reaction  Types 

Senile  dementia,  dementia  paralytica  (general  paralysis, 
syphilis  of  nervous  system).  Cause,  treatment,  prognosis. 
Laboratory  aids  to  diagnosis. 

VIII.  (Class)  Quiz  on  previous  lecture.  Nursing  procedures  in  re- 
tarded conditions,  deteriorations,  unconscious  states,  paralysis. 
Importance  of  attention  to  bodily  functions,  diet,  cleanliness, 
prevention  of  bed  sores,  etc.  Nursing  measures  in  treatment 


NURSING  IN   MENTAL   AND  NERVOUS   DISEASES  113 

by  salvarsan  or  mercury.    Methods  of  administering.    Obser- 
vation of  symptoms. 

IX.  (Lecture)    Delirium  and  Infectious  Exhaustive  States 

States  of  intoxication.  Alcoholic  and  drug  psychosis.  Hal- 
lucinosis. Value  of  treatment  by  elimination — drugs,  hydro- 
therapy,  etc. 

X.  (Class)  Quiz  on  lecture.  Nursing  procedures  in  delirium  and 
exhaustion.  Continuous  tubs,  packs,  sponges.  Various  pre- 
scribed treatments  by  eliminative,  sedative  or  stimulating 
drugs.  Precautionary  protective  measures  in  administering 
drugs  and  in  giving  treatments. 

XI.  (Lecture)    States  of  Defect:  Idiocy  and  Imbecility 

Types  of  personalities.  Constitutional  inferiority  and  psy- 
chopathic personalities.  Psychopathology.  Mental  conflict 
and  perversions  of  adjustment  and  behavior. 

XII.  (Class)  Quiz  on  lecture.  Description  of  terms  used  in  expres- 
sion of  mental  states  and  conditions.  Methods  of  dealing  with 
patient's  questions.  Observations  necessary  to  gain  the  confi- 
dence of  patients.  Disciplinary  methods.  The  necessity  for 
a  sympathetic  understanding  of  human  nature.  Observation 
of  habits  and  tendencies  to  perversions.  Preventive  measures. 

XIII.  (Lecture)    Dementia  Praecox 

Etiology,  types,  treatment. 

XIV.  (Class)    Quiz  on  lecture.    Observation  of  early  symptoms — 
habit    deteriorations,     etc.    Re-educative  measures.    Thera- 
peutic value  of  occupations  and  diversions.    Tube  feeding. 

XV.  (Lecture)    Manic-Depressive  Psychoses 

XVI.  (Class)  Quiz.  Management  of  resistive,  combative,  violent 
and  destructive  patients.  Precautionary  measures  against 
homicide  and  suicide  or  injury.  The  furnishing  of  rooms  of 
wards  for  excited  patients.  The  serving  of  meals.  Observa- 
tions to  prevent  accidents — care  of  keys,  doors,  locks,  sharp 
instruments,  clothing,  dishes,  etc.  Routine  necessary  for  pro- 
tection of  patients.  The  value  of  hydriatic  treatment  and  di- 
version. The  management  and  care  of  untidy  patients. 
XVII.  (Lecture)  Psychasthenia  and  Hysteria 

Psychoneuroses.    Minor  psychoses. 

XVIII.  (Class)  Quiz  on  lecture.  General  nursing  procedures  in  func- 
tional psychoses.  Value  of  rest,  isolation,  diet,  occupations, 
hydrotherapy,  diversions,  re-education,  environment,  good 
hygiene — mental  and  physical.  Management  of  hysterical 
convulsions.  Value  of  packs  and  continuous  tubs.  Methods  of 
dealing  with  delusions  and  hallucinations. 
XIX.  (Lecture)  Psychoanalysis  in  Diagnosis  and  Treatment 

Means  of  obtaining  data.  Mental  examinations.  The  value 
of  early  hospital  care.  The  nurse's  influence  in  the  community 
as  a  means  of  furthering  education  and  for  the  prevention  of 
mental  disease. 


114  OUTLINES  OF  SUBJECTS 

XX.  (Lecture)     Social  Aspects  of  Mental  Disease 

Economic  and  social  conditions  conducive  to  mental  and  nerv- 
ous diseases,  poverty,  over-work,  social  vices,  drugs  and  al- 
cohol, isolation,  etc.  Relation  of  mental  disorders  and  defects 
to  the  family,  to  occupation,  education,  prostitution,  crime  and 
lawlessness,  etc.  The  burden  on  the  community  for  the  care 
of  mentally  ill  and  defective.  Measures  for  the  prevention  and 
control  of  mental  disease. 

METHODS  OF  TEACHING 

1.  Few  hospitals  offer  a  special  department  in  psychiatry,  but 
there  is  usually  some  clinical  material  in  any  general  hospital, 
which  might  well  be  used  to  illustrate  the  principles  outlined 
above.     Some  of  these  are  the  mental  or  nervous  conditions 
following  or  accompanying  infectious  diseases,  toxemias,  al- 
coholism, advanced  heart  and  kidney  cases,  carcinoma  patients, 
drug  cases,  and  the  various  forms  of  hysteria  and  neurasthenia. 
Where  possible  an  affiliation  should  be  arranged  with  a  mental 
hospital  or  psychiatric  department,  giving  the  pupils  the  op- 
portunity for  more  continued  observation  and  experience  in  this 
very  important  branch  of  nursing. 

2.  As  in  other  medical  subjects  the  clinical  method  should  be 
used  wherever  possible,  and  every  effort  made  to  connect  the 
nursing,  medical  and  social  aspects  of  this  class  of  diseases. 

EQUIPMENT  AND  ILLUSTRATIVE  MATERIAL 

Charts  and  models,  case  notes,  lantern  slides  and  laboratory 
specimens. 

TEXT  AXD  REFERENCE  BOOKS 

Meyer  and  Kirby:  Notes  of  Clinics  in  Psychopathology. 
White:  Outlines  of  Psychiatry. 
White:  Principles  of  Mental  Hygiene. 
Kraeplin:  Clinical  Psychiatry,  Vol.  III. 
Barrus:  Nursing  the  Insane. 
Davenport:  Heredity  in  Relation  to  Eugenics. 
Richards:  Euthenics  "The  Science  of  Controllable  Environ- 
ment." 

Thorndike:  Elements  of  Psychology. 
Thorndike:  Individuality. 
James:  Psychology. 
Tiffany:  Life  of  Dorothea  Lynde  Dix. 
Dubois:  The  Education  of  Self. 
Dubois:  The  Influence  of  the  Mind  on  the  Body. 
Munsterberg:  Psychotherapy 
Hollander:  Nervous  Women. 
Chapin:  Compendium  of  Insanity. 
Beers:  The  Mind  that  Found  Itself. 

See  also  references  on  Occupation  Therapy,  and  Modern 
Social  Conditions. 


NURSING  IN  OCCUPATIONAL,  SKIN  AND  VENEREAL  DISEASES    115 

Nursing  in  Occupational,  Skin,  and  Venereal  Diseases 

TIME:  10  hours,  divided  as  follows: 

Lectures  and  clinics  by  physicians  (specialists) — 7  hours. 
Classes  and  demonstrations  by  nurses  (specially  equipped  in 
these  branches) — 2  hours. 
Lecture  by  social  service  nurse — 1  hour. 

OBJECTS  OP  COURSE 

1.  To  make  the  pupil  nurse  familiar  with  the  outstanding 
features  of  the  diseases  in  question,  so  that  she  may  be  able  to 
care  for  such  cases,  intelligently  and  skillfully  and  assist  in 
preventive  work. 

j.  To  help  her  to  understand  the  social  significance  of  these 
diseases  and  to  secure  her  interest  and  cooperation  in  remov- 
ing the  social  and  economic  causes  which  contribute  so  largely 
to  their  development. 

OUTLINE  OF  LECTURES  AND  CLASSES 

I  and  II.  (Lectures)     Occupational  Diseases 

Occupational  factors  in  disease  in  general.  Classification  of 
health  hazards.  Occupational  diseases  due  to  (a)  gases,  vapors 
and  high  temperature,  (b)  conditions  of  atmospheric  pressure, 
(c)  metallic  poisons,  dust  and  fumes,  (d)  organic  and  inorganic 
dust  and  heated  atmospheres,  (e)  fatigue.  Special  forms  of 
poisoning' — lead,  phosphorus,  arsenic,  mercury,  etc.  Parasitic 
diseases.  Fatigue — its  causes  and  effects.  Occupation  neu- 
roses. Industrial  accidents.  Nursing  care  of  occupational 
diseases. 

(For  principles  of  Industrial  Hygiene,  see  Public  Sanitation.) 
III.  (Lecture)     Venereal  Diseases- — Syphiliis 

History  of  syphilis.  Earliest  recorded  appearance  in  Europe. 
Discovery  of  germ  and  its  characteristics.  Clinical  and  lab- 
oratory methods  of  diagnosis.  Pathology  of  syphilis  and  gen- 
eral characteristics  of  acquired  syphilis.  Primary  stage  from 
venereal  and  non-venereal  infection.  Value  of  early  diagnosis. 
Secondary  stage — clinical  symptoms' — infectious  and  non-in- 
fectious lesions.  Tertiary  stage — general  symptoms  and  physi- 
cal complications  (mental,  nerve,  heart,  etc.)  Hereditary 
syphilis' — evidences  in  infants,  children  and  adults. 
IV.  (Lecture)  Gonorrhea 

History  of  gonorrhea.  Characteristics  of  gonococcus.  Clin- 
ical and  laboratory  methods  of  diagnosis.  Acute  gonorrhea, 
ophthalmia  neonatorum  and  vaginitis  in  children.  Symptoms, 
treatment  and  complications.  Manifestations  in  adults' — symp- 
toms, treatment  and  complications.  Mode  of  infection.  Pre- 
ventive measures.  Chronic  or  recurring  gonorrhea. 


116  OUTLINES   OF   SUBJECTS 

V.  (Class  and  Demonstration)  Quiz  on  preceding  lecture.  Nurs- 
ing care  of  patients  suffering  from  above  diseases.  Precautions 
regarding  infection.  Preparation  for  Wassermann  and  Leuten 
tests,  administration  of  salvarsan  (by  intravenous,  intraspinal, 
and  intramuscular  methods),  mercury  injectibns  and  inunctions, 
injection  of  silver  salts  and  topical  applications. 
VI.  (Lecture)  Diseases  of  the  Skin — Introduction 

Review  structure  and  function  of  the  skin  and  accessory  or- 
gans. Relation  to  nerve  supply  and  temperature  control.  The 
hygienifc  care  of  the  skin.  Pathology  of  skin  diseases.  Inflam- 
matory changes  of  pigment  and  the  causes  of  growths.  Classi- 
fication of  skin  lesions.  Assign  cases  for  observation  and  re- 
port. 
VII.  (Lecture)  Lesions  of  the  Skin 

Review  bacteriology  of  skin  diseases.    Types  of  lesions  in 
akin  proper  and  in  mucous  membranes.     Symptomfe — general 
and  local.    Characteristic  rashes.     Complications,  treatment 
and  general  precautions.     Board  of  Health  Regulations. 
VIII.  (Lecture)    Common  Skin  Diseases 

Occurrence,  causes,  symptoms,  treatment,  and  prophylaxis  of 
anaemia  of  the  skin,  hyperemia,  erythema,  eczema,  herpes, 
urticaria,  dermatitis,  impetigo,  psoriasis,  erysipelas  and  para- 
sitic diseases  of  the  skin. 

IX.  (Class)    Quiz  on  three  preceding  lectures.    Nursing  measures 
in  skin  diseases  with  special  reference  to  hygiene,  diet,  bathing, 
local  applications  and    dressings,   etc.    Starch  and  alkaline 
baths.     Preparation  for  X-ray  treatments. 
X.   (Lecture)     Social  Aspects  of  Skin  and  Venereal  Diseases 

Relation  of  housing,  living  conditions,  social  habits,  immi- 
gration, etc.,  to  skin  diseases.  Relation  to  occupation  and  to 
social  intercourse  (as  in  schools,  clubs,  etc.)  Relation  of  ve- 
nereal disease  to  prostitution,  blindness,  illegitimacy,  infant 
mortality,  insanity,  crime  and  other  social  problems.  Public 
Health  aspects  of  the  problem.  Legislation  and  publicity 
methods.  Reporting  of  cases  of  venereal  diseases.  The  men- 
ace of  charlatans  and  secret  remedies.  The  function  of  the  free 
and  pay  clinic. 

(For  social  and  economic  aspects  of  occupational  disease  and 
for  educational  problems  connected  with  sex-hygiene  see  under 
Modern  Social  Conditions.) 

METHODS  OF  TEACHING 

1.  Use  the  clinical  method  wherever  possible.  Have  pupil 
study  case  records  and  observe  typical  cases  in  wards  and  out- 
patients department  between  classes.  Dispensary  experience 
is  especially  valuable  in  connection  with  this  course. 

ILLUSTRATIVE  MATERIAL  AND  EQUIPMENT 

Bacteriological  slides  and  cultures,  charts  and  models,  pub- 
licity literature  and  exhibits. 


OPERATING  ROOM  TECHNIC  117 

TEXT  AND  REFERENCE  BOOKS 

Oliver:  Diseases  of  Occupation. 

Thompson:  Occupational  Diseases. 

Goldmark:  Fatigue  and  Efficiency. 

Dock:  Hygiene  and  Morality. 

Morrow:  Social  Diseases  and  Marriage. 

Stelwagon:  Diseases  of  the  Skin. 

Jackson:  Diseases  of  the  Skin. 

Meachen:  Diseases  of  the  Skin  for  Nurses. 

Publications  of  Society  of  Moral  and  Sanitary  Prophylaxis 
(N.  Y.).  American  Social  Hygiene  Association  and  State 
Departments  of  Health — (See  Oregon  and  other  state  and 
local  publications). 

Operating  Room  Technic 

TIME:  10  hours.  Classes  and  demonstrations  I  to  VIII  conducted  by  the 
operating-room  nurse.  Lectures  IX  and  X  by  a  physician  or 
trained  anesthetist.  Course  given  in  the  second  year. 

OBJECTS  OF  THE  COURSE 

1.  To  give  the  pupil    nurse  a  good  scientific  basis  for  the 
surgical  technic  of  the  operating  room,  to  introduce  her  to  the 
various  methods  and  procedures  in  use  in  all  forms  of  operative 
work,  whether  in  the  hospital  or  outside,  and  to  help  in  develop- 
ing the  "aseptic  conscience." 

2.  To  make  the  pupil  familiar  with  the  equipment  of  the  op- 
erating-room, its  cost,  use,  and  care,  and  to  help  her  in  the 
preparation  of  standard  supplies. 

3.  To  give  her  a  general  idea  of  the  use  and  action  of  anes- 
thetics, so  that  she  may  be  able  to  care  for  the  patient  and  assist 
the  anesthetist  more  intelligently,  and  if  necessary  administer 
an  anesthetic  in  an  emergency,  under  a  surgeon's  direction. 

NOTE.  It  is  not  the  intention  here  to  have  the  pupil  special- 
ize in  either  operating-room  work  or  anesthetics.  This  would 
require  a  1'dnger  preparation  and  should  be  deferred  till  after 
graduation. 

OUTLINE  OF  CLASSES 

I.  The  Operating  Room  and  its  Equipment 

The  relation  of  this  department  to  others  in  the  hospital. 
Structure,  finishings,  and  furnishings  of  the  operating-room 
and  suite.  Temperature  and  moisture  of  air.  Light.  Care 
and  cleaning  of  the  room  and  equipment.  Manipulation  of 
tables,  etc.  The  operating-room  staff,  its  duties  and  responsi- 
bilities. Special  need  for  intelligence,  concentration,  and 
trustworthiness  on  part  of  operating-room  nurses.  Organiza- 
tion of  the  daily  service.  Surgical  nomenclature. 


118  OUTLINES   OF   SUBJECTS 

II.  The  Sterilizing  Room 

Review  of  surgical  bacteriology  and  principles  of  sterilization. 
Construction,  operation,  and  care  of  autoclave  and  sterilizers. 
Fractional  and  single  sterilization.  Disinfectant  solutions  in 
the  operating-room.  Their  preparation  and  use.  Sterilization 
of  utensils,  pitchers,  basins,  etc. 

III.  Instrument  and  Supply  Room 

Names  of  instruments.     Care,  cleaning,  and  sterilization. 

Drugs  and  solutions,  kinds,  preparations,  and  sterilization. 
Storage  and  care  of  splints,  sandbags,  and  mechanical  appli- 
ances. Care  of  actual  cautery  and  special  apparatus. 

IV.  Preparation  of  Dressings  and  Supplies 

Preparation  and  sterilization  of  gauze  dressings,  pads,  pack- 
ings, drains,  bandages,  needles,  sutures,  ligatures,  and  linen 
supplies  (gowns,  masks,  sheets,  swathes,  etc.)    Storing  and  as- 
sembling supplies. 
V  and  VI.  The  Operation 

Essentials  of  aseptic  technic.  Results  of  broken  technic. 
Necessity  for  good  team  work  in  securing  speed  and  efficiency. 
Fitting  up  the  operating-room.  Preparation  of  surgeon  and 
nurse.  Preparation  of  the  patient.  Positions  on  the  table, 
support  and  draping.  Preparation  of  the  site  of  operation. 
Operative  steps.  The  sponge  count.  Emergency  measures,  in- 
fusions, transfusions,  etc.  Duties  of  each  member  of  the  oper- 
ating and  assisting  staffs.  Removing  patient  from  the  table. 
After  care  and  clearing  away.  Care  of  pathological  specimens. 
VII.  Modifications  of  Technic  for  Special  Types  of  Operation 

Selection  of  instruments,  dressings,  sutures,  etc.,  for  opera- 
tion on  head,  neck,  liver  and  gall  bladder,  kidney,  vagina,  etc. 
Also  for  fractures,   orthopedic    cases,  minor  operations  and 
septic  cases. 
VIII.  The  Emergency  Operating-Room 

Equipment  of  the  emergency  operating-room.  Emergency 
technic.  Minimum  requirements.  Typical  emergencies  as  a 
result  of  mine  disasters,  train  wrecks,  etc.,  and  their  handling, 
with  and  without  standard  equipment.  Night  operations.  Ar- 
rangements of  light  and  other  special  adjustments. 
IX  and  X.  Anesthetics 

History  of  anesthesia.  Types  of  anesthetics,  local,  spinal, 
and  general,  and  their  uses.  Types  of  inhalers.  The  equip- 
ment of  the  anesthetic  room.  The  anesthetic  table  and  stimu- 
lating tray.  Oxygen  apparatus.  Nurse's  care  of  the  patient 
before,  during,  and  after  the  anesthetic.  Principles  to  be  ob- 
served in  the  administration  of  the  commoner  anesthetics. 
The  preliminary  steps.  Unfavorable  symptoms.  Accidents. 
After-effects.  Mental  influences  in  relation  to  anesthesia. 
Technic  of  anoci-association. 


EMERGENCY  NURSING  AND   FIRST  AID  119 

METHOD  OP  TEACHING 

1.  The  classes  should  be  held  in  the  operating-room  where 
pupils  can  see  and  hatodle  the  equipment  and  where  demonstra- 
tions can  be  set  up  by  the  instructor  and  the  pupils.    Observa- 
tion of  one  or  two  operations  would  help  to  illustrate  the  main 
principles  and  methods. 

2.  If  it  is  possible  it  would  be  better  to  give  this  course  to 
smaller  groups,  taking  those  who  have  just  begun  their  operat- 
ing-room training  or  who  are  soon  to  begin  i4;.    The  class  and 
practical  work  would  then  supplement  and  reinforce  each  other. 
If  it  is  impossible  to  give  ftine  for  regular  organized  class 
work,  the  subject  should  be  covered  through  individual  instruc- 
tion and  demonstration  with  supplementary  readings  in  good 
reference  books. 

3.  Quizzes  should  be  given  frequently,  and  drills  on  essen- 
tial points.    Students  should  not  be  required  to  memorize 
lists  of  instruments  and  supplies  but  should  if  possible  have 
typewritten  sheets  giving  typical  layouts,  which  can  be  re- 
ferred to  when  needed. 

EQUIPMENT  AND  ILLUSTRATIVE  MATERIAL 

The  equipment  of  the  operating-room.  Catalogues  of  sup- 
ply houses  giving  names  and  prices  of  instruments,  furniture, 
utensils,  etc.  Skeleton,  charts,  etc.,  as  required. 

TEXT  AND  REFERENCE  BOOKS 

Parker  and  Breckinridge :  Surgical  and  Gynecological  Nursing. 

Howell:  Surgical  Nursing  and  Hospital  Technic. 

Robb:  Aseptic  Surgical  Technic. 

Senn:  Opera  ting-Room  Technic. 

Fowler:  The  Operating-Room  and  the  Patient. 

Smith:  The  Operating  Room. 

Emergency  Nursing  and  First  Aid 

TIME:  10  hours.  Classes  and  demonstrations  conducted  by  the  nurse 
instructor,  or  by  a  physician  and  nurse  who  are  especially  com- 
petent to  handle  this  subject.  To  be  given  in  the  latter  part 
of  the  senior  year. 

OBJECTS  OP  THE  COURSE 

1.  This  short  course  is  intended  to  help  the  nurse  to  adapt 
her  hospital  methods  a  little  more  readily  to  the  situations 
which  she  will  meet  on  graduation,  especially  to  emergency 
conditions  such  as  may  be  met  in  army  work,  in  accidents  of 
various  kinds,  and  in  pioneer  service  where  equipment  and 
facilities  are  limited. 

2.  Such  a  course  will  also  serve  as  a  review  of  practical  nurs- 
ing principles  and  procedures  for  students  who  intend  to  take 


120  OUTLINES   OF   SUBJECTS 

the  state  examinations.  Quick  thinking,  adaptability,  re- 
sourcefulness, economy  and  speed,  would  be  emphasized  as  well 
as  careful  technic. 

3.  The  demand  for  classes  in  elementary  nursing  and  first 
aid  to  be  given  to  clubs  and  groups  of  various  types  is  increas- 
ing so  rapidly  that  nurses  should  be  prepared  to  assist  in  such 
teaching  and  should  thus  be  in  touch  with  the  latest  and  most 
approved  methods  in  emergency  work. 

OUTLIVE  OF  CLASSES  AND  DEMONSTRATIONS 

I.  Introduction 

General  principles  and  scope  of  first-aid  work.  Qualities 
demanded  and  dangers  to  be  avoided.  Materials  required. 
First-aid  outfits  of  various  types.  Improvised  outfits.  Or- 
ganization of  nursing  service  in  case  of  fires,  railway  accidents 
and  other  public  disasters.  Organization  for  service  in  time 
of  war. 
II  and  III.  Transportation  of  the  Injured 

General  principles  to  be  observed  in  transportation.  Ve- 
hicles available.  Ambulances.  Improvised  vehicles.  Stretch- 
ers'— manufactured  and  improvised.  Loading  and  carrying 
stretchers,  carrying  over  obstructions,  up  and  down  stairs,  etc. 
Carrying  patients  in  a  chair,  hammock  or  blanket-sling.  Car- 
rying pick-a-back  and  in  arms.  The  fireman's  lift.  The  two, 
three  and  four-handed  seat.  Special  methods  of  transportation 
in  fires,  in  case  of  flood,  etc.  Stretcher  drill. 
IV  and  V.  Surgical  Emergencies 

Essentials  of  surgical  first-aid.  Emergency  dressings  and 
methods  of  sterilization  and  disinfection.  Improvised  splints, 
padding  and  bandages  for  use  in  fractures,  dislocations,  sprains, 
etc.  Improvised  tourniquets.  First-aid  treatment  of  frac- 
tures, wounds,  burns,  bruises,  frost-bites,  etc.,  of  various 
types.  Treatment  of  hemorrhage. 
VI  and  VII.  Medical  Emergencies 

States  of  unconsciousness.  Various  causes  and  how  to  dis- 
tinguish commoner  conditions.  First-aid  treatment  of  fainting, 
shock,  apoplexy,  intoxication,  convulsions  (of  commoner  types), 
sun-stroke,  heat  exhaustion,  electrical  shock,  drowning,  chok- 
ing, gas  and  drug  poisoning. 
VIII.  Adaptation  of  Nursing  Measures 

Surroundings,  conditions  and  facilities  usually  found  in  city 
tenements,  in  country  districts,  in  military  camps,  mining  dis- 
tricts, etc.  Essentials  of  sick-room  sanitation  and  personal 
care  under  any  of  these  conditions.  Modification  of  treatments 
to  be  worked  out  on  basis  of  resources  available. 
IX  and  X.  (Two-hour  period)  Demonstration  of  Nursing  Measures 

The  following  problems  are  suggested: — Putting  up  a  croup- 
tent  in  a  city  tenement;  making  a  camp  bed;  giving  a  slush 


SPECIAL  DISEASE   PROBLEMS  121 

bath  in  a  camp  bed;  giving  a  hot  pack  in  a  camp  or  country 
house;  preparing  for  an  obstetrical  case  in  a  private  house; 
preparing  for  an  operation  in  a  private  house  or  camp;  care  of 
shock  under  emergency  conditions,  etc. 

METHODS  OF  TEACHING 

1.  Since  most  of  the  principles  covered  in  this  course  should 
be  familiar  to  senior  nurses,  the  main  effort  will  be  to  have 
them  work  out  the  applications  as  a  test  of  their  understanding 
and  resourcefulness.     Problems  should  be  assigned  ahead  of 
time  and  each  individual  should  be  responsible  for  some  part  of 
the  discussion  and  demonstration. 

2.  It  is  suggested  that  the  demonstrations  be  made  before 
the  school  and  the  pupils  rated  on  the  points  most  essential  in 
first-aid  work. 

3.  An  excellent  way  of  developing  interest  in  such  a  course 
is  to  have  the  pupils  assist  in  giving  classes  to  a  small  group 
of  factory  girls,  boy  or  girl  scouts  or  camp-fire  girls.     Great 
care  should  be  taken,  however,  that  the  work  should  be  very 
elementary  in  character  and  thoroughly  taught. 

EQUIPMENT  AND  ILLUSTRATIVE  MATERIAL 

1.  Beds,  bedding,  utensils,  furnishings  and  surgical  materials 
as  for  other  nursing  classes,  with  a  variety  of  common  house- 
hold and  out-door  materials  to  be  used  for  improvising  equip- 
ment. 

2.  First-aid   outfits   for  use  in   factories,   mine   accidents, 
schools  and  households,  army  kit,  Red  Cross  kit,  outfit  for 
automobile  trips,  etc. 

3.  First-aid  charts  (Red  Cross  and  other  kinds). 

TEXT  AND  REFERENCE  BOOKS 

Morrow:  Immediate  Care  of  the  Injured. 
Lynch:  Red  Cross  Text-book  on  First-aid  and  Relief  Columns. 
Wharton :  Minor  Surgery  and  Bandaging. 
Doty:  Prompt  Aid  to  the  Injured. 
Eliason:  First  Aid  in  Emergencies. 
See  also  text-books  in  Nursing,  Medicine  and  Surgery. 

Special  Disease  Problems  (Elective) 

TIME:  10  hours.    Conferences,  case  studies  and  written  reports.    Con- 
ducted by  experts  in  different  subjects  studied. 

OBJECTS  OF  COURSE 

1.  The  idea  is  to  give  each  senior  student  an  opportunity  of 
making  a  more  extended  study  of  some  method  of  treatment 
or  some  one  disease  or  class  of  diseases,  taking  the  case  as  the 


122  OUTLINES   OF   SUBJECTS 

unit  of  study,  and  coordinating  all  the  various  aspects  (pathol- 
ogy, therapeutics,  nursing,  etc.)  previously  studied  as  separate 
subjects. 

2.  To   test   out   their  ability   to  work   out  an  independent 
problem  as  they  will  have  to  do  when  they  leave  the  hospital, 
to  consult  sources  and  gather  material  for  themselves  and  to 
organize  the  results  of  their  observation  and  inquiry  in  the 
form  of  a  report  or  case  history,  such  as  might  be  published 
in  a  nursing  journal. 

3.  To  study  any  new  or  special  forms  of  disease  or  treatment 
which  may  have  been  slighted  or  overlooked  in  the  previous 
courses. 

SUGGESTED  PROBLEMS 

These  would  vary  widely,  according  to  the  special  interest  of 
the  student,  and  the  material  at  hand.  Problems  along  the 
following  lines  might  be  suggested: 

I.  Newer   methods    of   treatment   in    pneumonia,    infantile 
paralysis,  typhoid  or  any  otjier  disease. 

II.  Devices  for  improving  nursing  technic  and  increasing 
efficiency  in  nursing  procedures. 

III.  Special  dietary  studies. 

IV.  Special  forms  of  therapeutics. 

V.  Nursing  treatment  of  rare  or  unusual  cases. 

VI.  Study  of  a  hospital  epidemic. 

VIII.  Special  features  in  any  branch  of  nursing — obstetrical, 
children's,  mental  and  nervous,  etc. 

IX.  Study  of  certain  symptoms  or  phases  of  disease  such  as 
shock,  post-operative  vomiting,  chill,  crises,  symptoms  of  ap- 
proaching death,  sleeplessness,  delirium,  etc. 

METHODS  OF  TEACHING 

1.  A  great  deal  of  this  work  would  have  to  be  individual. 
General  direction  and  advice  could  be  given  by  the  best  quali- 
fied person  available,  but  the  student  must  do  the  greatest 
part  of  the  work  herself. 

2.  A  few  conferences  of  the  class  would  be  held  to  present 
reports  of  the  work  being  done,  so  that  each  student  would 
profit  by  the  results  of  the  others'  work. 

3.  These  should  be  supplemented  by  lectures  by  specialists 
on  any  new  or  interesting  subjects  connected  with  the  study  and 
treatment  of  disease. 

TEXT  AND  REFERENCE  BOOKS 

See  under  preceding  subjects. 


F.  SOCIAL  AND  PROFESSIONAL  SUBJECTS 

History  of  Nursing  (including  Ethical  and  Social  Principles) 

TIME:  15  hours,  divided  as  follows: 

Classes  I  to  X  conducted  by  the  superintendent  of  nurses  or 
instructor — 10  hours. 

Classes  XI  to  XV  given  by  the  social  service  worker  or  visit- 
ing nurse — 5  hours.  This  course  to  be  given  in  the  early  part 
of  the  preparatory  year. 

OBJECTS  OF  COURSE 

1.  To  arouse  interest  and  enthusiasm  in  nursing  as  an  occu- 
pation, by  introducing  the  pupil  nurse  early  to  the  long  and 
splendid  history  of  nursing,  and  the  great  leaders  who  have 
established  its  traditions  and  ideals. 

2.  To  make  them  appreciate  some  of  the  obstacles  that  have 
been  overcome  in  making  the  profession  what  it  is,  sind  some 
of  the  opportunities  which  are  open  to  them  in  the  future. 

3.  To  explain  the  origin  and  meaning  of  hospital  regulations 
and  hospital  etiquette,  and  to  secure  the  cooperation  of  the 
pupil  nurse  in  carrying  out  the  purposes  of  the  hospital  har- 
moniously and  effectively. 

4.  To  interest  the  pupil  from  the  beginning  in  the  social  as 
well  as  the  medical  aspects  of  her  work  and  give  her  some 
realization  of  the  social  and  economic  conditions  which  bring 
patients  to  the  hospital  and  complicate  recovery. 

5.  To  encourage  in  the  pupil  a  sympathetic  attitude  toward 
her  patients  as  people,  a  better  understanding  of  their  prob- 
lems and  the  conditions  under  which  they  live,  and  to  make 
her  more  ready  and  able  to  cooperate  with  the  social  service 
department  and  other  agencies  in  helping  them., 

OUTLINE  OF  CLASSES 

I  to  X.  History  of  Nursing- — including  ethical  principles 
I.  Introduction: 

Brief  discussion  on  the  meaning  of  nursing,  the  present  de- 
mands in  hospital  work,  and  the  ideals  which  pupils  bring  to 
their  new  task.  Reasons  for  the  study  of  nursing  history — to 
understand  and  appreciate  nursing  traditions  and  ideals,  to 
study  the  stages  of  development  through  which  nursing  has 
passed,  to  note  the  people  and  influences  which  hare  helped 
to  make  the  profession  what  it  is  and  to  find  out  the  origin  of 
common  observances  and  customs.  Explanation  of  the  pur- 
pose of  training  and  those  features  of  hospital  life  which  are  of 
immediate  importance  to  new  pupils.  A  very  brief  outline  of 
the  main  periods  in  general  history  reviewed  as  a  basis  for 
nursing  history. 

123 


124  OUTLINES  OF  SUBJECTS 

II.  The  Origin  and  Early  Development  of  Nursing 

Original  meaning  of  nursing — "to  nourish."  Maternal  or 
parental  instinct,  the  root  of  the  nursing  impulse  shown  in 
protection,  nourishment,  care  and  fondling  of  young.  Nurs- 
ing and  first-aid  among  animals.  Rudiments  of  nursing  care 
among  primitive  peoples.  Influence  of  religious  beliefs  and 
ceremonials  on  the  care  of  the  sick.  Early  rites  of  hospitality 
— their  relation  to  ancient  institutions  for  the  care  of  sick 
strangers.  Gradual  development  in  standards  of  humanity 
and  justice.  Beginning  of  public  relief  for  sick  and  unfortu- 
nate. General  standards  of  hygiene,  sanitation,  therapeutics, 
nursing  and  medical  science  in  ancient  civilizations.  Hippoc- 
rates'— the  "Father"  of  medicine — influence  on  medicine  and 
nursing.  Ethical  ideals  as  shown  in  the  Hippocratic  Oath. 
Countries  where  nursing  is  still  in  the  primitive  stage  of  de- 
velopment. 

III.  Influence  of  Christianity  on  Nursing.     The  Ascetic  or  Saintly 
Ideal 

Influence  of  Christian  ideas  of  brotherhood,  pity,  charity 
and  self-sacrificing  service  seen  in  the  work  of  the  deacons 
and  deaconnesses  of  the  early  church — first  organized  nursing 
service.  Relief  of  sick  and  unfortunate  gradually  taken  over 
by  the  church.  Hospitals  established  as  religious  and  char- 
itable institutions.  Nursing  advocated  as  a  form  of  religious 
discipline  and  service.  Paula,  Marcella  and  Fabiola — types 
of  nursing  leaders  of  this  period.  Growth  of  monastic  institu- 
tions and  tendency  toward  seclusion  from  the  world  and  the 
contemplative  life  rather  than  the  active  ife  of  service. 
Emphasis  on  ascetic  practices' — penance,  self-mortification  and 
self-abnegation.  Monasteries  as  centres  of  relief  and  hospi- 
tality. Nursing  and  medical  work  of  monks  and  nuns.  Influ- 
ence of  prevalent  superstititions,  and  belief  in  magic  and 
miracle  on  the  care  of  the  sick.  Radegunde  and  Hildegard, 
types  of  monastic  women. 
IV.  Aristocratic  and  Military  Influences.  The  Romantic  or  Knightly 

Ideal 

Rise  of  the  institution  of  chivalry  with  new  ideal  of  the 
Christian  knight,  defender  of  the  weak  and  helpless  and  re- 
dressor  of  human  wrongs.  Life  of  struggle,  adventure  and 
romance  opposed  to  the  repressed,  sheltered,  contemplative 
life  of  the  cloister.  Virtues  of  the  warrior-knight,  robust, 
active  and  positive — courage,  hardihood,  honor,  courtesy, 
loyalty,  leadership,  etc.  Combination  of  chivalric  and  monas- 
tic ideals  in  military  nursing  orders  developed  during  the  cru- 
sades. Hospital  expansion  under  the  knightly  orders.  Intro- 
duction of  aristocratic  and  military  features  in  hospital  organi- 
zation and  management.  Knights  of  St.  John  as  types  of 
Hospitallers.  Influence  of  knightly  and  military  ideals  on 
later  hospital  nursing.  Red  Cross  and  army  work. 


HISTORY   OF  NURSING  125 

V.  Democratic  and  Secular  Tendencies  in  Mediaeval  Nursing 

Rise  of  the  mendicant  order  under  Saint  Francis  of  Assisi 
as  a  reaction  against  extreme  forms  of  monasticism  and  aris- 
tocratic tendencies  of  military  orders.  Friars — a  democratic 
organization  bringing  spirit  of  brotherhood  and  ideals  of  prac- 
tical religion  into  every  day  life.  Nursing  one  of  many  forms 
of  active  social  service  undertaken  by  mendicants,  illustrated 
by  St.  Francis'  work  among  the  lepers.  Founding  of  secular 
and  semi-secular  orders  for  nursing  and  relief  opened  avenues 
of  service  to  people  in  common  walks  of  life  and  led  to  higher 
ideals  of  citizenship.  Extreme  restrictions  and  ascetic  dis- 
cipline of  monastic  orders  no  longer  considered  essential  to 
nursing  and  charitable  work.  The  Tertiaries  of  St.  Francis, 
and  the  Beguines,  types  of  voluntary  secular  orders  organized 
on  a  religious  basis.  St.  Catherine  of  Siena  and  St.  Elizabeth 
of  Hungary  types  of  non-monastic  nursing  saints  and  popular 
heroines  of  mediaeval  times.  Cities  and  communities  begin- 
ning to  undertake  some  responsibility  for 'relief  and  care  of  sick 
and  unfortunate  and  prevention  of  poverty  and  distress.  Re- 
vival of  interest  in  medicine  after  a  long  period  of  indifference 
and  neglect,  and  study  of  medicine  in  the  early  universities. 

VI.  The  Dark  Period  in  Nursing 

Decline  in  many  of  the  religious  orders  and  general  dete- 
rioration in  hospital  and  nursing  work.  Suppression  of  many 
orders.  Hospitals  gradually  taken  over  by  civil  authorities. 
Servant  nurses  generally  employed  for  the  care  of  the  sick  both 
in  religious  and  civil  hospitals.  "Sairey  Gamp"- — type  of  the 
ignorant,  secular,  servant  nurse  or  "monthly  nurse."  Low 
ideals  of  honesty,  personal  morality,  dignity  and  humanity. 
Standards  of  hospital  service  very  low.  Amateur  "Lady 
Bountiful"  type  of  nursing  and  charitable  work  in  parish  and 
country  districts.  Work  of  missionary  nurses  in  Canada  com- 
pared with  servant  nurses  and  religious  orders  at  home. 
Countries  where  nursing  is  at  present  largely  in  the  hands  of 
servant  nurses  and  amateurs. 

VII.  Humanitarian  Movements  of  the  Early  Modern  Period 

Beginnings  of  organized  charity  in  France  (17th  C)  under 
leadership  of  Vincent  de  Paul.  Sisters  of  Charity — new  type 
of  nursing  and  relief  organization.  Reforms  in  care  of  pris- 
oners, insane  and  sick  in  hospitals,  stimulated  by  work  of 
John  Howard,  Elizabeth  Fry,  William  Tuke,  Dr.  Pinel  and 
other  humanitarian  leaders.  Revival  of  deaconess  work  by 
the  Fliedners  of  Kaiserworth.  Humanitarian  and  religious 
ideals  combined  in  these  newer  nursing  organizations,  with 
beginnings  of  definite  standards  of  nursing  work  and  training. 
Gradual  advance  in  medicine  as  a  result  of  discoveries  of  Har- 
vey and  other  scientists.  Revival  of  surgery  through  barber 
surgeons,  Pare"  and  others. 


126  OUTLINES   OF  SUBJECTS 

VIII.  Modern  Nursing  Established  by  Florence  Nightingale 

Story  of  Florence  Nightingale's  life  and  work.  Her  new 
conception  of  nursing  as  an  economically  independent  secular 
vocation  or  art  demanding  intelligence,  knowledge  and  skill, 
as  well  as  devotion  and  moral  purpose.  The  necessity  of  long 
and  careful  training  emphasized  and  the  first  schools  of  nurs- 
ing established.  Ideals  of  nursing  as  shown  by  Florence 
Nightingale's  example  and  teachings.  Influence  of  the  growing 
freedom  and  independence  of  women  on  nursing  work. 

IX.  Recent  Developments  in  Nursing 

Scientific  advances  of  the  19th  C  in  medicine,  surgery,  sani- 
tation, anesthetics,  etc.,  due  to  the  work  of  Pasteur,  Lister, 
Morton  and  others.  Social  and  philanthropic  movements  a< 
seen  in  the  work  of  Dorothea  Dix,  Octavia  Hill,  etc.  Founding 
of  the  Red  Cross.  Work  of  Dunant,  Clara  Barton  and  others. 
Educational  advancements,  especially  in  the  education  of 
women.  The  influence  of  all  these  movements  on  nursing. 
Founding  of  first  nursing  schools  in  America.  Pioneer  leaders 
in  nursing  education.  Founding  of  nursing  organizations. 
Modern  expansion  of  the  field  of  nursing. 
X.  Modern  Professional  Ideals  and  Standards 

Evidences  of  religious,  ascetic,  military,  democratic  and 
humanitarian  ideals  in  nursing  of  the  present  day.  Status  of 
nursing  in  principal  countries  of  the  world.  What  it  means  to 
be  a  member  of  a  profession.  Application  of  nursing  ideals  and 
spirit  to  practical  problems  of  hospital  life.  Origin  and  mean- 
ing of  hospital  etiquette,  hospital  discipline,  the  uniform,  etc. 
Responsibility  of  nurses  in  maintaining  the  great  traditions  of 
nursing. 
Periods  XI  to  XV.  Social  Aspects  of  Nursing  and  Hospital  Work 

XI.  Relation   of  Nursing  and  Hospital   Work   to   Community  and 

Family  Welfare 

Brief  survey  of  nursing  history  to  show  the  identification  of 
nursing  with  all  forms  of  social  and  philanthropic  work  in  the 
past.  Nursing  still  essentially  a  form  of  social  work.  The 
hospital  also  essentially  a  social  institution  bound  up  inti- 
mately with  family  and  community  welfare.  Meaning  of  com- 
munity or  social  welfare.  Recent  changes  in  the  conception  of 
all  charitable  and  philanthropic  work.  New  emphasis  on  pre- 
ventive and  constructive  measures.  Definition  of  "society" — 
"social."  Elements  for  which  adequate  provision  must  be 
made  in  a  normal  or  healthy  community — health,  education, 
employment,  recreation,  moral  and  spiritual  life.  Importance 
of  the  family  in  community  life.  Biological  and  social  func- 
tions of  the  family.  Training  for  citizenship  and  life  in  larger 
social  groups.  Deficiencies  in  institutional  typo  of  upbringing. 
General  effects  of  family  disorganization  and  disintegration. 
Efforts  to  conserve  the  family  and  promote  its  influence  and 
wolf  are. 


HISTORY  OF  NURSING  127 

XII.  Some  Social  Problems  as  Seen  in  the  Hospital 

Types  of  patients  seen  in  the  wards  and  dispensary  who  rep- 
resent social  problems  of  various  kinds — drug  habitues,  pros- 
titutes, unmarried  mothers,  tramps  and  rounders,  dependents, 
alcoholics,  patients  with  venereal  diseases,  patients  with  other 
communicable  diseases,  foreigners,  victims  of  industrial  dis- 
eases and  accidents,  etc.  Social  causes  operating  to  bring 
these  people  to  the  hospital — ignorance,  poverty,  lack  of  sani- 
tation and  sanitary  control  on  part  of  community,  bad  in- 
dustrial conditions,  etc.  In  case  of  foreigners  all  of  above 
combined  with  exploitation  and  lack  of  adaptation  to  American 
conditions.  What  the  social  service  department  tries  to  do  for 
these  people. 

XIII.  How  Adverse  Social  and  Economic  Conditions  Operate  in  Child- 

hood 

In  infancy  bad  heredity  due  to  alcoholism,  mental  defect, 
degeneracy  of  parents,  etc.,  insufficient  care  of  mother  before 
and  after  childbirth  and  of  child  at  birth  and  during  early 
period,  inability  of  mother  to  nurse  child,  impure  milk,  bad 
sanitary  surroundings,  mother's  ignorance,  etc.  In  childhood 
— lack  of  care,  due  to  ignorance,  poverty,  resulting  in  malnu- 
trition and  bad  environment,  bad  housing,  etc.  Effects  of 
communicable  diseases  of  childhood,  physical  defects,  child 
labor,  bad  sanitary  conditions  at  school  and  lack  of  medical 
inspection  and  nursing.  (Specific  examples  of  these  condi- 
.  tions.) 

XIV.  How  Adverse  Social  and  Economic  Conditions  Operate  in  Adult 

Life 

Effects  of  poverty  and  insufficient  wages,  communicable  dis- 
eases (especially  tuberculosis),  bad  housing,  overcrowding, 
unemployment,  bad  working  conditions  resulting  in  industrial 
diseases  and  accidents,  insufficient  opportunity  for  recreation, 
etc.  Special  difficulties  in  the  case  of  immigrant  families. 
Problems  of  mental  defectives. 
XV.  Local  Social  and  Economic  Conditions 

Make  a  broad  general  survey  of  the  community  or  section 
of  the  city  in  which  the  hospital  is  located,  noting  its  history, 
population  (number,  characteristics,  nationalities,  etc.), 
health  activities  (state  and  local  milk  supply,  institutions 
for  the  sick,  preventive  work,  housing);  industries  (kinds, 
legal  regulations,  dangerous  occupations,  etc.),  opportunities 
for  recreation;  social  institutions  (churches,  schools,  settle- 
ments, clubs,  etc.).  Show  how  the  character  of  the  community 
and  its  problems  affect  the  work  done  in  the  hospital  and  how 
the  hospital  affects  the  community.  Show  how  pupil  nurses 
can  assist  in  making  the  hospital  work  most  effective  socially 
as  well  as  medically. 


128  OUTLINES   OF   SUBJECTS 

METHOD  OF  TEACHING 

1.  In  such  a  short  course  it  is  impossible  and  unnecessary  to- 
take  up  many  detailed  historical  facts.     If  the  pupils  get  a 
good  general  picture  of  the  progress  of  nursing  and  the  inter- 
esting personalities  and  events  which  have  helped  to  mould 
it,  if  they  catch  the  spirit  of  the  great  leaders,  and  their  inter- 
est is  aroused  in  the  literature  of  nursing,  the  greatest  result 
will  have  been  achieved.     The  class  and  discussion  method  is 
to  be  preferred  to  the  lecture  for  most  of  this  course. 

2.  It  is  essential  that  some  view  of  the  general  historical 
background  should  be  given  before  taking  up  the  nursing  his- 
tory.    A  rough  tabulated  chart  of  the  chief  historical  epochs 
and  events  of  European  history  according  to  centuries  will 
help  to  place  the  general  scheme  before  the  pupil's  mind  and 
will  enable  her  to  correlate  her  nursing  and  general  history 
better. 

3.  Every  means  should  be  taken  to  make  the  events  and  the 
personalities    vivid    and    concrete.     Pictures    are    invaluable 
and  fortunately  there  are  many  excellent  ones  available.     A 
collection  of  historical  books  adds  greatly  to  the  interest. 

4.  In  the  social  topics  the  first  effort  should  be  to  arouse  in- 
terest in  people  rather  than  in  abstract  principles  and  prob- 
lems.    Specific  cases  should  be  studied  as  types' — preferably 
patients  the  pupils  have  met  in  the  wards  or  out-patients  de- 
partment.    Only  the  essential  elements  in  each  case  should  be 
pointed  out  and  anything  like  a  mere  curious  or  sentimental 
interest    should    be    discouraged.     Hopelessly    tragic    cases 
should  not  be  selected,  and  the  opportunities  and  methods  of 
helpful  constructive  work  along  very  simple  lines  should    be 
suggested.     There  should  be  no  attempt  to  teach  methods  of 
social  work  at  this  stage — but  pupils  can  be  assigned  to  help  in 
running  messages,  amusing  children,  dressing  and  undressing 
them,  etc.,  so  getting  an  insight  into  the  problems  of  the  dis- 
pensary. 

5.  In  addition  to  selected  readings  and  class  reports,   the 
pupils  should  visit  some  of  the  social  institutions  and  agen- 
cies in  the  community,  and  each  individual  should  accompany 
the  social  service  worker  or  visiting  nurse  in  her  home  visits 
for  a  few  afternoons  to  get  a  good  picture  of  home  conditions. 

ILLUSTRATIVE  MATERIAL 

Photographs  of  pictures  illustrating  care  of  the  sick  in  an- 
cient and  modern  times,  nursing  saints,  medical  and  nursing 
leaders,  historic  institutions,  etc.  Pictures,  exhibits  and 
charts  illustrating  social  conditions  and  the  work  of  social 
agencies.  Bulletins  and  pamphlets  published  by  various  social 
organizations. 


HISTORY  OP  NURSING  129 

TEXT  AND  REFERENCE  BOOKS 

I.  History  of  Nursing 

History  of  Nursing:  Nutting  and  Dock,  4  vols. 

Cooke :  Life  of  Florence  Nightingale,  2  vols. 

Tooley:  History  of  Nursing  in  the  British  Empire. 

Robinson  and  Breasted:  Outlines  of  European  History. 

Berdoe:  Origin  and  Growth  of  the  Healing  Art. 

Withington:  Medical  History  from  the  Earliest  Times. 

Tuker  and  Malleson:  Handbook  to  Christian  and  Ecclesiasti- 
cal Rome. 

Putnam:  The  Lady. 

Mozans:  Women  in  Science. 

Loch:  Charity  and  Social  Life. 

Saleeby:  Surgery  and  Society. 

Richards:  Reminiscences  of  Linda  Richards. 

Tiffany :  Life  of  Dorothea  Dix. 

Dickens:  Martin  Chuzzlewitt. 

Epler:  Life  of  Clara  Barton. 

Boardman:  Under  the  Red  Cross  Flag. 

Articles  in  Encyclopedia  Britannica  under  Medicine,  Monas- 
ticism,  Chivalry,  Church  History,  Mendicant  Orders,  St. 
Francis,  etc. 

Paget:  Confessio  Medici. 

Richer:  L'Art  et  la  Medicene. 

Lacroix:  Military  and  Religious  Life  of  the  Middle  Ages. 

Mullerheim :  Die  wochenstube  in  der  Kunst. 

(The  last  three  especially  interesting  for  their  illustrations.) 
(See  also  under  Nursing  Ethics,  Professional  Problems,  etc.) 

II.  Social  Aspects  of  Nursing 

Wald:  The  House  on  Henry  Street. 

Hunter:  Poverty  (especially  chapters  I  and  IV). 

Devine:  Misery  and  Its  Causes  (especially  chapters  I  and  II). 

Devine:  The  Normal  Life. 

Reports  of  the  Federal  Children's  Bureau  (especially  Infant 

Mortality  Series,  no.  3,  Johnstown  Report). 
Kelley:  Modern  Industry  (especially  chapters  I  and  II). 
Elwood:  Sociology  and  Modern  Social  Problems — Chap.  IV- 

VIII  inclusive. 

Addams:  Twenty  Years  in  Hull  House. 
Addams:  The  Spirit  of  Youth  and  the  City  Streets. 
Addams:  Democracy  and  Social  Ethics. 
Commons :  Races  and  Immigrant  in  America. 
Steiner:  On  the  Trail  of  the  Immigrant. 
Osier:  An  Alabama  Student  and  Other  Essays. 
Ross:  Social  Psychology. 
Lee:  Social  work  with  Families  and  Individuals,  published  by 

the  New  York  School  of  Philanthropy  and  other  pamphlets. 
Byington:  What  Social  Workers  should  know  about  their  own 


130  OUTLINES   OF  SUBJECTS 

Communities  (Pamphlet  published  by  Russell  Sage  Foun- 
dation, New  York). 
The  Survey:  (Journal  of  Social  Work). 

Elements  of  Psychology 

TIME:  10  hours.  Lectures  and  class  discussions.  Taught  by  a  psy- 
chologist or  a  qualified  nurse  or  social  worker.  Given  in  the 
latter  part  of  the  first  year. 

OBJECTS  OF  COURSE 

1.  To  attempt  to  state  the  fundamental  principles  underly- 
ing human  conduct. 

2.  To  give  the  student  practice  in  considering  people's  ac- 
tions with  impersonal  understanding  and  sympathy. 

3.  To  develop  certain  principles  for  dealing  wisely  with  pa- 
tients and  others  in  professional  relations. 

4.  To  help  the  student  toward  self-mastery  and  good  sense 
in  the  relationships  of  private  life. 

5.  To  provide  a  basis  for  subsequent  courses  in  psychiatry 
or  ethics. 

OUTLINE  OF  CLASSES 

I.  Psychology  the  Science  of  Behavior 

Behavior  considered  as  responses  to  "stimuli."     People  con- 
sidered as  organisms  adjusting  to  changing  environment,  nat- 
ural and  social,  by  acting  upon  the  environment.     Behavior 
such  adjustment. 
II.  Adjustment  made  by  the  Nervous  System 

Its  structure — brain,  cord,  fibres,  sympathetic  system; 
neurones.  Functions.  Nervous  pathways  Readiness. 

III.  Pathways  Due  to  Original  Nature 

Reflexes.  Instincts,  their  nature.  Typical  instincts.  Read- 
iness and  the  original  satisfiers.  Modifying  instincts. 

IV.  Individual  Differences  in  Behavior 

Central  tendencies — the  "curve  of  distribution."    Causes  of 
differences.     Heredity— race  and  family,  variations.     Age,  sex, 
and  past  experience. 
V.  Effect  of  Past  Experience  on  Behavior 

Learning.     Habits.    The     "laws    of    learning."    Practice. 
Specific  nature  of  habits. 
VI.  Variety  of  Responses  to  Same  Stimulus 

Influence    of    accompanying    circumstances.     "Mind    set," 
mood,  temperament.     Influence  of  weather,   health,  fatigue, 
drugs,  emotional  state,  purpose,  etc.,  on  responses. 
VII.  Thinking 

Physiological  basis.  Attention  and  interest.  Memorizing. 
Association  and  analysis.  Studying,  "appcrceptive  mass." 
Reasoning. 


PRINCIPLES   OF  ETHICS  131 

VIII.  Feeling 

Pleasantness.      "Satisfiers     and     annoyers."     Associative 
shifts  of  satisfaction.    Emotions,  their  dependence  on  organic 
action.    Control  and  use  of  feeling. 
IX.  Doing 

Will  and  habit.    Selection  and  attention  in  willing.     Individ- 
ual differences  in  will.    Morality,  social  basis,  psychological 
elements.     "Character." 
X.  Suggestion 

.  Presenting  the  stimulus  that  calls  forth  the  desired  act.  Tact. 
Use  of  principles  already  discussed.  Understanding  people. 
Self-mastery. 

METHODS  OF  TEACHING 

Class  discussion  based  on  simple  text-book  if  possible.  Lec- 
ture on  points  for  which  text-book  is  not  available.  Reference 
reading.  Written  and  oral  reports  of  actual  experiences,  and 
questions  from  pupils  relating  to  individual  problems. 

EQUIPMENT  AND  ILLUSTRATIVE  MATERIAL 

Anatomical  charts  and  models  of  brain  and  nervous  system. 

REFERENCE  BOOKS 

Thorndike:  Elements  of  Psychology. 

Thorndike:  Educational  Psychology.     (Briefer  course, — 1914.) 

Thorndike :  Individuality. 

Colvin  and  Bagley:  Human  Behavior. 

James:  Psychology.     (Briefer  course.) 

James:  Talks  to  Teachers  on  Psychology. 

Pillsbury:  Essentials  of  Psychology. 

Miller:  Psychology  of  Thinking. 

Ribot:  Diseases  of  the  Personality. 

Ribot:  Diseases  of  the  Will. 

Kirkpatrick:  Fundamentals  of  Child  Study. 

Tyler:  Growth  and  Education. 

Principles  of  Ethics 

TIME:  10  hours.  Classes  and  conferences  conducted  by  the  superinten- 
dent of  nurses  or  a  special  lecturer.  Given  in  the  second 
year. 

OBJECTS  OF  THE  COURSE 

1.  To  follow  up  the  work  of  the  first  year  in  the  historical 
and  social  aspects  of  nursing  by  a  fuller  discussion  of  the  prin- 
ciples of  behavior,  their  origin,  meaning  and  practical  bear- 
ings on  the  common  experiences  and  problems  of  life. 

2.  To  try  to  lead  the  pupil  to  formulate  more  clearly  and  defi- 
nitely her  philosophy  of  life,  to  stimulate  her  in  the  formation 
of  the  right  kind  of  personal  habits,  to  help  her  in  building  up 


132  OUTLINES   OF   SUBJECTS 

a  strong  and  an  attractive  personality,  and  to  give  her  a  vision 
of  what  a  full,  happy,  useful,  and  well-ordered  life  may  be. 

3.  The  effort  is  made  here  to  build  up  broad  general  principles 
which  apply  equally  well  to  all  phases  of  life  and  all  types  of 
people,  rather  than  to  emphasize  a  special  code  which  is  re- 
stricted to  one  group  and  one  type  of  occupation. 

OUTLINE  OF  CLASSES 

I.  Introduction — Customary  Morality 

Meaning  and  derivation  of  ethics,  morals,  customs.  Dis- 
tinguish from  etiquette,  manners,  religion.  Kind  of  pjoblems 
considered  in  a  study  of  ethics  (give  concrete  examples) <YT3asis 
of  all  behavior  found  in  the  original  nature  of  man  with  its 
equipment  of  instincts  ( and  tendencies,'  These  neither  good 
nor  bad  in  themselves,  but  become  good  or  bad  according  to 
their  effect  on  other  human  beings.  Repetition  and  resulting 
satisfaction  the  conditions  of  development.  Four  levels  of 
stages  of  conduct:  (1)  Instincts,  controlled  and  influenced 
only  by  physical  pains  and  pleasures;  (2)  modified  by  rewards 
and  punishments;  (3)  controlled  by  the  thought  of  praise  or 
blame;  (4)  Conduct  regulated  by  a  personal  ideal  which  enables 
one  to  do  right  even  when  it  entails  personal  suffering  and  the 
condemnation  of  society.  First  stage  non-moral,  represented 
by  infants  and  mental  defectives.  Most  people  in  second  and 
third  st&ges' — where  custom  and  tradition  are  principal  guides 
to  conduct  (group  or  customary  morality).  Customs  and  laws 
gradually  built  up  by  the  social  group  for  its  own  welfare  and 
protection,  and  habits  enforced  through  ritual  and  ceremony, 
force  of  public  opinion  or  physical  force.  Weakness  and  lim- 
itations in  this  kind  of  morality. 

II.  Personal  or  Reflective  Morality 

Personal  as  opposed  to  group  or  customary  morality  involves 
free  choice  and  independent  moral  judgment,  instead  of  un- 
reasoning acceptance  of  custom  and  slavish  imitation  of  others. 
Social  habits  and  customs  still  determine  conduct  to  a  large 
extent  but  the  individual  is  responsible  and  accountable  for  his 
own  actions.  His  conduct  becomes  purposeful,  voluntary,  and 
spontaneous,  as  opposed  to  impulsive  or  forced  conduct.  Laws 
which  he  first  obeyed  mechanically,  he  learns  to  obey  ration- 
ally. In  this  stage  of  conduct,  morals  are  differentiated  from 
manners,  conscience  substituted  for  custom,  and  principles 
for  rules  of  conduct.  '  Personal  or  reflective  morality  has  three 
aspects:  (1)  right  feeling  or  a  delicate  sensitiveness  to  ethical 
ideals  and  an  ardent  desire  to  realize  them;  (2)  right  thinking 
or  sound  moral  judgment;  (3)  right  doing  or  the  vigorous  carry- 
ing out  of  one's  purposes  and  ideals.  This  is  conscientiousness 
or  obedience  to  the  inward  law  "where  the  person  himself 
sets  up  the  ideal  standard,  judges  his  conduct  by  it,  holds  him- 


PRINCIPLES   OF  ETHICS  133 

self  responsible  to  himself  and  seeks  to  do  justice."  Con- 
science is  not  infallible — needs  constant  enlightenment  and 
training,  must  be  kept  sensitive  and  responsive,  and  must  be 
obeyed  as  the  highest  moral  law  which  the  individual  knows. 

III.  Ethical  Ideals  and  Standards 

Ethical  ideals  are  the  product  of  all  the  preceding  ages  and 
of  all  one's  experiences  in  life.  The  body  of  accepted  moral 
and  ethical  principles  have  very  slowly  accumulated  and  are 
constantly  undergoing  changes  and  modifications.  Each  age 
works  out  a  different  conception  of  moral  worth  or  goodness. 
Great  moral  leaders  are  those  who  break  through  traditions  and 
customs,  and  establish  new  ideals  of  conduct.  They  are  the 
prophets,  saints,  martyrs,  and  reformers.  Moral  ideals  are 
embodied  in  art,  literature,  religion,  law,  etc.  Earliest  ethical 
principles  of  high  value  found  in  Hebrew  and  Greek  literatures. 
The  Roman  law  and  the  Christian  Church,  the  main  sources 
of  later  ethical  standards  and  the  great  conservative  forces  in 
preserving  old  standards.  Examples  of  early  ethical  teachings 
seen  in  the  ten  commandments,  the  golden  rule,  proverbs, 
fables,  etc.  Ethical  influence  of  great  characters  in  history, 
biography,  fiction,  and  contemporary  life. 

IV.  Moral  Judgment 

The  second  essential  to  reflective  morality,  is  sound  moral 
judgment  or  wisdom,  "the  parent  or  nurse  of  all  the  virtues." 
Element  of  choice  and  moral  valuation  implies  capacity  for 
reflection,  discrimination  and  sound  thinking  as  well  as  an 
adequate  body  of  knowledge  to  guide  one's  decision.  Imagi- 
nation needed  to  forecast  possible  results  of  any  given  choice 
and  to  see  the  wider  and  more  remote  as  well  as  the  immedi- 
ate results.  Sympathetic  insight  into  others'  lives  and  a  wide 
acquaintance  with  human  nature  necessary  to  insure  just  judg- 
ments. Wisdom  needed  in  deciding  means  to  be  used  as  well 
as  ends  to  be  realized.  Wisdom  means  insight,  sagacity,  san- 
ity, and  common  sense;  not  to  be  confused  with  mere  knowl- 
edge. Moral  judgment  not  essentially  different  from  judgments 
required  in  business  or  professional  matters.  Ability  to  judge 
wisely  in  some  degree  inherited,  but  may  be  developed  by  exer- 
cise and  self-criticism.  Impulsive,  capricious,  or  "snap"  judg- 
ments likely  to  be  superficial  and  unreliable.  Prejudice  and 
strong  emotion  warp  judgment.  Dogmatism  and  intolerance 
usually  based  on  narrow  range  of  facts,  and  shallow  thinking. 
Until  facts  can  be  obtained,  judgment  should  be  suspended. 
V.  Conduct  and  Character 

The  third  essential — will  power  or  moral  energy  to  control 
vagrant  or  selfish  impulses  and  carry  out  one's  purpose  and 
ideals.  High  ideals  and  thoughtful  decisions  are  ineffective 
unless  put  into  practice.  Those  who  profess  fine  ideas  and  emo- 
tions without  doing  anything  to  carry  them  out  are  called  sen- 


134  OUTLINES   OF   SUBJECTS 

timentalists  or  hypocrites.  Motive  power  comes  from  the 
emotions  and  sentiments  which  are  the  springs  of  action  as  well 
as  the  key  to  character.  What  a  person  is,  is  shown  by  what 
he  desires  most,  what  annoys,  pains,  or  grieves  him,  in  what  he 
finds  satisfaction.  Disposition  and  temperament  are  largely 
inherited,  but  character  is  made.  It  is  the  result  of  all  one's 
choices  and  actions,  of  all  one's  physical,  mental  or  moral 
habits.  Important  to  make  allies  instead  of  enemies  of  one's 
habits.  Rules  for  habit-formation  (see  James).  Action  must 
be  vigorous  and  forceful  as  well  as  rightly  directed — must  be 
applied  consistently  in  all  the  affairs  of  every-day  life. 
VI.  The  Place  of  "the  Self"  in  the  Moral  Life 

Virtues  are  habits  of  will  or  modes  of  conduct  which  tend  to 
promote  the  welfare  of  both  individual  and  collective  life. 
Vices  are  abnormal  developments  of  the  will  that  tend  to  en- 
slave and  destroy  life.  The  normal  impulse  of  individuals  is  to 
satisfy  the  desires  and  claims  of  self.  The  higher  welfare  of 
self  includes  the  welfare  of  the  larger  group.  Involves  struggle 
between  egoism  and  altruism,  between  narrow  selfishness  and 
benevolence.  Self-control  the  mainspring  of  character — mas- 
tery of  the  lower  by  the  higher  impulses.  Suppression  and 
eradication  of  natural  impulses  and  emotions  and  extreme 
self-renunciation  as  advocated  by  ascetics  tend  to  cripple  and 
narrow  life.  Self-expression  and  self-development  to  be  em- 
phasized, as  well  as  self-denial  and  self-sacrifice.  Courage  or 
persistent  natural  vigor  needed  to  resist  lower  desires  and 
give  moral  power  to  meet  pain,  danger,  and  public  disapproval, 
when  necessary.  Strong  character  implies  virility,  vigor,  and 
strong  moral  fibre, not  negative, spineless  "goodyness."  Mod- 
esty (freedom  from  false  pride  and  excessive  desires),  chastity, 
self-possession,  perseverance,  fortitude,  patience,  constancy — 
all  aspects  of  self-control  and  courage.  A  high  conception  of 
individual  honor,  self-respect,  and  wholesome  ambition,  essen- 
tial to  complete  development  of  the  self.  Vanity,  servility,  ag- 
gressiveness, etc.  are  perversions  of  the  impulse  to  further 
self's  welfare  and  development. 
VII.  The  Social  Virtues 

The  parental  or  "motherly"  instinct — the  main  root  of  the 
social  virtues.  Tenderness,  compassion,  sympathy,  pity,  be- 
nevolence, and  helpfulness,  generally  expressed  in  various 
forms  of  charity  and  philanthropy,  such  as  caring  for  children, 
the  sick,  helpless,  and  dependent.  Unless  safeguarded  by 
knowledge  and  good  judgment,  benevolence  may  be  injurious 
to  oneself  and  others.  Good  will,  or  love  of  one's  neighbor,  is 
incompatible  with  envy,  malice,  and  all  the  subtle  as  well  as 
active  forms  of  cruelty  and  selfishness.  Patriotism  or  love  of 
one's  country — another  form  of  benevolence.  Justice  a  funda- 
mental social  virtue,  representing  the  idea  of  equity,  rectitude, 


PRINCIPLES  OF  ETHICS  135 

fairness,  impartiality,  honesty  as  opposed  to  exploitation,  op- 
pression or  injustice  of  all  kinds.  Veracity  implies  frankness, 
fidelity,  and  sincerity  in  all  human  relationships  as  opposedto 
lying,  flattery,  slander,  and  misrepresentation.  Social  virtues 
of  cooperation,  good-will,  fair  play,  give  and  take,  enter  into 
every  phase  of  human  life  and  work. 
VIII.  Ethical  Principles  as  Applied  to  Community  Life 

The  growth  of  democracy  in  modern  life.  Result  of  growing 
belief  in  the  worth  and  possibilities  of  the  individual  and  his 
right  to  self-expression  and  development.  Danger  of  over- 
emphasis on  individual  rights  and  neglect  of  obligations.  New 
emphasis  on  social  ends  or  group  welfare,  not  incompatible 
with  individual  development.  Social  efficiency  the  modern 
ideal— highest  self-realization  and  self-expression  through 
service  for  the  common  good  Wide  variation  in  types  of  serv- 
ice and  ability  needed  for  community  service.  Public-spirited- 
ness  and  patriotism  expressed  in  the  faithful  doing  of  incon- 
spicuous and  common  tasks  as  well  as  heroic  deeds.  Impor- 
tance of  training  and  efficiency  as  well  as  good-will.  Recent 
changes  in  the  status  of  women  and  new  possibilities  of  public 
service  opened  up.  Local  questions  of  family  and  community 
welfare  discussed  from  the  ethical  point  of  view  with  practical 
suggestions  for  useful  service. 
IX.  Principles  of  Ethics  as  Applied  to  One's  Work  or  Profession 

The  relation  of  various  forms  of  occupation  to  community 
welfare.  Ideals  and  traditions  of  service  developed  by  such 
professions  as  the  church,  the  army,  medicine,  etc.  The 
spirit  of  the  craftsman  or  artist  in  relation  to  his  art.  Putting 
one's  soul  into  one's  work.  The  value  of  work  as  .a  means  of 
happiness,  personal  satisfaction,  and  development.  "/Growth  in 
independence,  integrity,  industry,  and  self-respect  through 
work.  The  "business-like"  qualities  and  virtues — system, 
thoroughness,  promptness,  alertness,  economy,  reliability,  and 
persistence.  Qualities  demanded  in  working  with  others — 
loyalty  and  intelligent  cooperation  with  those  in  charge,  trust- 
worthiness, ability  to  do  good  team-work,  spirit  of  courtesy 
and  helpfulness,  a  sense  of  humor,  discretion.  Qualities  neces- 
sary in  leading  and  guiding  others' — good  judgment,  justice, 
dignity,  generosity,  initiative,  enthusiasm,  self-reliance,  and 
the  ability  to  take  responsibility.  Dangers  of  narrowness  and 
stagnation  in  relation  to  one's  occupation;  of  materialism,  cyni- 
cism, and  mechanical  routine.  Effects  of  over-fatigue,  and 
over-work  as  well  as  idleness  in  breaking  down  moral  resistance, 
decreasing  moral  sensitiveness,  and  sapping  energy  and  spirit. 
X.  Principles  of  Ethics  as  Applied  to  One's  Personal  Life 

The  importance  of  having  definite  purposes  to  work  towards, 
laws  to  obey,  ideals  to  follow.  Self-direction  and  self-mastery 
achieved  thrpugh  concentration  and  practice.  The  place  of 


136  OUTLINES   OF   SUBJECTS 

religion  in  the  building  of  character,  and  the  development  of 
one's  spiritual  life.  Essentials  of  an  attractive,  wholesome, 
and  strong  personality.  Its  influence  on  others.  Possibili- 
ties of  strengthening  weak  moral  fibre  and  cultivating  hidden 
resources  of  personality  and  ability  in  others.  The  ability  to 
meet  moral  crises  in  one's  own  life  and  the  lives  of  others. 
Provision  for  growth.  What  we  mean  by  self-government. 
Application  of  foregoing  principles  to  special  problems,  es- 
pecially those  involved  in  recreation,  amusements,  and  social 
life,  dress  and  the  expenditure  of  money,  relations  between 
men  and  women,  friendships,  etc. 

METHODS  OF  TEACHING 

l.'The  practice  of  ethics  is  a  matter  of  attitude,  spirit,  and 
1-Will  more  than  knowledge.  Teaching  will  never  be  effective  in 
changing  behavior  unless  it  is  backed  up  by  the  example  and 
personality  of  the  teacher  and  by  the  atmosphere  and  influ- 
ences which  surround  the  pupil  every  day.  Every  subject 
taught  in  the  training  school  should  be  a  medium  for  teaching 
ethics,  and  every  problem  which  the  pupil  meets  in  her  daily 
work  should  be  an  opportunity  for  practice  in  ethics.  The 
social  life  of  the  pupil  nurse  is  a  particularly  strong  influence 
in  shaping  her  ideals  and  developing  her  powers.  Emphasis 
should  be  laid  on  the  formation  of  habits  of  positive  service 
and  helpfulness  rather  than  merely  the  correction  of  faults 
and  the  observation  of  rules  and  regulations;  on  the  strength- 
ening of  character  through  complete  development  rather  than 
the  repression  and  elimination  of  the  more  undesirabletraits. 
If  the  principles  of  student  government  are  in  force  in  the 
Nurses'  Home,  it  will  give  a  much  better  opportunity  for  exer- 
cising the  qualities  of  self-direction  and  self-control  in  regard 
to  the  pupils'  personal  life. 

2.  In  teaching  ethics,  concrete  examples  should  be  given  to 
illustrate  every  point,  or  to  lead  up  to  the  discussion.    These  ex- 
amples will  be  found  in  history  and  standard  literature,  poetry, 
current    fiction,    newspaper    items    or    personal    experiences. 
It  is  better  not  to  draw  too  many  examples  from  hospital  life 
but  to  give  as  broad  a  point  of  view  as  possible.     Pupils  should 
be  asked  to  bring  in  examples  and  to  contribute  to  the  discus- 
sions in  every  possible  way.     The  course  should  be  tied  up 
with  the  earlier  course  in  the  historical  and  social  aspects  of 
nursing  and  to  psychology  if  this  is  given.     It  might  follow  the 
course  in  psychology  or  be  combined  with  it  if  there  is  not  time 
for  both. 

3.  If  possible  personal  conferences  might  supplement  such  a 
course.     The  teacher  could  thus  get  into  closer  touch  with  the 
pupils  and  could  help  them  better  in  working  out  their  indi- 
vidual problems. 


SURVEY  OF  THE   NURSING   FIELD  137 

TEXT  AND  REFERENCE  BOOKS 

Robb:  Ethics  of  Nursing. 

Parsons:  Nursing  Problems  and  Obligations. 

Nightingale :  Notes  on  Nursing. 

Nightingale:  Talks  to  Pupil  Nurses. 

Osier:  Aequanimitas. 

Dewey  and  Tufts:  Ethics. 

Mackenzie:  Manual  of  Ethics. 

McDougall:  Social  Psychology. 

James:  Talks  to  Teachers. 

McCunn:  Making  of  Character. 

Emerson:  Essays. 

Cabot,  (E.  L.)  Every-Day  Ethics. 

Cabot,  (Richard)  What  Men  Live  By. 

See  also  under  Historical,  Ethical  and  Social  Aspects  of 
Nursing,  Psychology  and  Problems  of  Professional  Life. 

Survey  of  the  Nursing  Field 

TIME:  10  hours,' — lectures,  classes  and  conferences  conducted  by  the 
superintendent  of  nurses  and  special  lecturers  representing 
different  fields.  Given  in  the  early  part  of  the  third  year. 

OBJECTS  OP  COURSE 

1.  To  introduce  the  pupil  nurse  to  all  the  varied  branches  of 
nursing  work,  so  that  she  may  be  more  able  to  choose  the 
field  in  which  she  is  likely  to  find  the  greatest  interest  and 
success. 

2.  To  show  pupils  what  is  being  done  in  all  these  important 
fields,  what  the  main  problems  are  and  what  their  responsi- 
bilities are  in  connection  with  them. 

OUTLINE  OF  CLASSES 
I.  Introduction 

Brief  survey  of  the  historical  development  of  nursing  work 
showing  the  division  into  three  main  branches  of  hospital, 
visiting  and  private  nursing.  Later  subdivision  of  each  of 
these  main  branches  into  many  distinct  fields.  Reasons  why 
nurses  should  choose  future  work  with  care.  Points  to  be 
considered  in  choice  of  vocation.  Need  of  further  training  for 
special  branches  or  positions  of  leadership.  Kinds  of  train- 
ing available.  Points  to  be  considered  in  regard  to  post-gradu- 
ate training. 
II.  Hospital  or  Institutional  Nursing 

History  of  the  origin  and  development  of  hospital  nursing 
reviewed.  Nature  and  general  conditions  of  work,  salaries, 
qualifications  and  preparation  for  executive  positions,  such  as 
hospital  superintendent,  assistant  superintendent,  dietitian, 


138  OUTLINES  OF  SUBJECTS 

housekeeper,  matron  of  nurses  home,  etc.  Technical  special- 
ties such  as  operating-room  work,  administration  of  anes- 
thetics, massage,  hydrotherapy,  electro-therapy,  laboratory 
work,  etc.  Duties,  opportunities,  qualifications  and  training 
demanded. 

III.  Educational  Work  in  Hospitals 

The  origin  and  development  of  training  schools  and  the 
work  of  the  training-school  as  distinguished  from  that  of  the 
hospital.  The  position  and  duties  of  the  superintendent  of 
nurses,  assistant  superintendents,  instructors  and  head  nurses. 
Qualities  and  training  demanded.  The  scope  of  educational 
work  in  nursing  schools.  Number  of  training  schools  in  U.  S. 
(approximately  1570).  Growing  importance  of  this  field. 

IV.  Visiting  Nursing  (General) 

The  origin  of  visiting  nursing  under  deaconesses  and  older 
religious  orders  reviewed.  Later  secular  orders,  and  rise  of 
modern  visiting  nursing.  Outline  of  modern  expansion  at 
home  and  abroad.  Leaders  in  this  field.  Outstanding  features 
of  visiting  nursing  in  urban  and  rural  districts.  Work  of  town 
and  country  nursing  service.  Visiting  nursing  in  connection 
with  insurance  companies,  etc.  Duties  of  visiting  nurse — 
qualifications  and  training  demanded. 
V.  Infant  Welfare  Work  and  School  Nursing 

Origin  of  modern  movements  for  conservation  of  children. 
Nurse's  part  in  this  movement  at  home  and  abroad.  Baby- 
welfare  work  in  hospitals,  dispensaries,  milk  stations  and 
homes.  Pre-natal  work.  Origin  of  school  nursing  and  rapid 
expansion  of  this  field.  The  position  and  duties  of  such  nurses 
including  resident  nurse  in  school  or  college  dormitory.  The 
qualifications  and  training  demanded. 
VI.  Tuberculosis  and  Industrial  Nursing 

Place  of  the  nurse  in  the  tuberculosis  movement.  Kinds  of 
positions  open  to  nurses  both  in  institutional  and  visiting 
work.  The  special  needs  of  this  field.  The  new  industrial 
welfare  work  for  nurses — its  nature  and  possibilities.  Duties, 
salaries,  requirements  and  training  of  nurses  for  these  branches. 
VII.  Mental  Hygiene  and  Medical  Social  Service 

History  of  the  care  of  the  insane  reviewed.  The  place  of  the 
nurse  in  mental  hygiene  and  mental  nursing.  Kinds  of  posi- 
tions open  in  both  institutional  and  visiting  work.  The  un- 
usual demands  and  opportunities  in  this  field.  The  origin  and 
development  of  medical  social  service.  The  nature  of  the  work 
and  the  demands,  requirements  and  special  preparation  of 
nurses  for  these  fields. 
VIII.  Red  Cross,  Army  and  Navy  Nursing 

History  of  the  Red  Cross  and  army  nursing.  Organization 
of  nursing  service  for  war  and  other  disasters  in  America  and 
in  other  representative  countries.  Service  in  army  and  navy 


SURVEY  OP  THE   NURSING   FIELD  139 

hospitals.     Nature  and  possibilities  of  such  work.    Require- 
ments and  special  preparation  of  nurses  for  these  fields. 
IX.  Private,  Hourly  and  Office  Nursing 

Origin  and  development  of  these  branches.  The  scope  of 
the  field.  Duties  and  economic  status  of  private  nurse.  Pros- 
pects for  advancement.  Newer  specialties  in  private  nursing. 
Qualifications  required  and  preparation  for  each  of  these 
fields. 
X.  Miscellaneous  Branches 

Nursing  in  home  and  foreign  mission  fields,  inspection  of 
Training  Schools,  work  of  hospital  consultant,  work  of  secre- 
tary or  organizer  of  philanthropic  or  public  health  organiza- 
tions, almshouse  and  prison  nursing,  sanitary  inspection, 
teaching  of  invalid  occupations,  etc.  Nature  and  general 
conditions  of  work  in  all  these  fields.  Salaries,  qualifications 
and  preparation  demanded. 

METHODS  OF  TEACHING 

1.  Class  or  lecture  method,  especially  interesting  if  special- 
ists in  the  representative  branches  could  come  in  and  tell  of 
their  work. 

2.  If  at  all  possible,  students  should  have  an  opportunity  of 
observing  something  of  the  principal  branches  of  work  out- 
side of  the  hospital  and  should  have  enough  experience  in  each 
of  the  three  main  branches  to  enable  them  to  test  out  their 
aptitudes  and  determine  which  field  they  want  to  enter. 

EQUIPMENT  AND  ILLUSTRATIVE  MATERIAL 

Books,  pamphlets,  journals  and  pictures,  lantern  slides. 
TEXT  AND  REFERENCE  BOOKS 

Nutting  and  Dock:  History  of  Nursing,  vols.  I-IV. 

Robb:  Nursing  Ethics. 

Robb:  Educational  Standards 

Wald:  The  House  on  Henry  Street. 

Opportunities  in  the  Field  of  Nursing:  (Pamphlet.) 

Perkins:  Vocations  for  the  Trained  Woman. 

Kingsbury:  Vocations  for  Trained  Women. 

Morley:  Women  Workers  in  Seven  Professions. 

Gulick  and  Ayres:  Medical  Inspection  in  Schools. 

Boardman:  Under  the  Red  Cross  Flag. 

La  Motte:  Tuberculosis  Nursing. 

Crowell:  Tuberculosis  Dispensary  Method  and  Procedure. 

Waters:  Visiting  Nursing  in  the  United  States. 

Cannon:  Social  Work  in  Hospitals. 

De  Witt:  Private  Duty  Nursing. 

Gardner:  Public  Health  Nursing. 

Struthers:  School  Nursing. 

Parsons:  Nursing  Problems  and  Obligations. 


140  OUTLINES   OF   SUBJECTS 

Reports  of  League  of  Nursing  Education. 
American  Journal  of  Nursing:  (Complete  Files). 
Public  Health  Nurse  Quarterly. 

See  also  under  Private  Nursing,  Public  Health  Nursing, 
Institutional  Work  and  Professional  Problems. 

Professional  Problems 

TIME:  10  hours.  Classes  and  conferences  conducted  by  the  superinten- 
dent of  nurses,  and  special  lectures.  Given  in  the  later  part 
of  the  senior  year. 

OBJECTS  OF  COURSE 

1.  To  anticipate  some  of  the  problems  which  will  confront 
the  pupils  when  they  graduate,  and  to  help  them  to  meet 
their  difficulties  in  a  rational  high-minded  and  effective  way. 

2.  To  awaken  their  interest  in  professional  organizations, 
and  to  secure  their  enthusiastic  cooperation  in  advancing  the 
mutual  interests  of  the  public  and  their  own  profession. 

(Special  problems  of  the  private  nurse,  the  public  health 
nurse,  and  the  institutional  nurse  are  considered  in  courses 
on  these  subjects.) 

OUTLINE  OF  CLASSES 

I.  The  Social  and  Civic  Status  of  Nurses 

Claims  of  nurses  to  professional  status  based  largely  on  serv- 
ice rendered  to  the  public  and  on  controlling  ethical,  and  edu- 
cational principles.  Responsibility  of  individual  nurse  in 
maintaining  professional  and  social  status.  Qualities  and  con- 
duct which  make  one  acceptable  in  good  society.  The  nurse 
as  a  citizen  and  public  servant.  What  the  community  has  a 
right  to  expect  of  her.  Duties  in  times  of  crisis- — war,  epidem- 
ics, etc.  Responsibility  for  community  health  and  welfare1. 
Relationship  to  civic,  philanthropic,  religious,  educational  and 
public  health  agencies  and  activities.  Relations  to  women's 
clubs  and  organizations  which  aim  to  advance  the  welfare  of 
women. 
II.  Professional  Ethics  and  Etiquette 

Origin  of  the  ethical  code  of  medicine.  Accepted  forms  of 
professional  courtesy.  Relation  of  the  nurse  to  the  physician 
in  all  the  various  branches  of  nursing  work.  Relations  of  indi- 
vidual nurses  to  one  another,  and  to  the  profession  as  a  whole. 
The  necessity  of  loyalty,  harmony  and  cooperation.  Primary 
rights  of  the  patient  and  patient's  family  in  case  of  doubt.  Pos- 
sible conflicts  between  the  general  good  and  professional  soli- 
darity. Nurses'  attitude  to  incompetents,  irregulars,  and 
quacks  in  both  nursing  and  medical  professions.  Professional 
courtesies  toward  representatives  of  related  professions  and 
occupations. 


PROFESSIONAL  PROBLEMS  141 

III  and  IV.  Nursing  Economics 

The  economic  status  of  the  nurse  as  compared  with  other 
professional  women.  The  professional  as  opposed  to  the  com- 
mercial spirit.  The  economic  independence  of  the  modern  pro- 
fessional nurse  compared  with  the  comparative  dependence  of 
the  religious  orders.  Provision  for  sickness  and  retirement. 
Business  principles,  as  applied  to  bills,  banking,  investments, 
insurance,  etc.  The  nurse's  budget.  Proportion  of  yearly  in- 
come spent  in  rent,  board,  clothing,  etc.  Principles  of  econ- 
omy. Loan  and  relief  funds  for  nurses.  The  sliding  scale  of 
charges.  Provision  for  maintenance  of  health  and  working  ca- 
pacity. Regulation  of  conditions  of  work  in  all  branches  of 
nursing — hours,  vacations,  living  conditions,  rest,  sleep,  food, 
etc.  The  social  life  of  nurses.  Provision  for  recreation  and 
self-improvement.  Nurses'  clubs  and  hostels.  Nurses'  regis- 
tries. Professional  vs.  commercial  bureaus.  The  central  reg- 
istry— how  it  should  be  maintained  and  managed. 
V.  Legal  Problems  (given  by  a  lawyer) 

Laws  which  affect  the  nurse  in  her  relations  with  patients, 
physicians,  hospitals  and  the  general  public.  Legal  situations, 
in  which  a  nurse  may  be  involved' — accidents,  sudden  death, 
poisoning,  suicide,  homicide,  insanity,  etc.  Court  procedures 
— especially  those  involving  testimony  by  nurses.  General 
advice  to  nurses  in  all  cases  where  legal  difficulties  arise. 
VI.  Nursing  Education 

Educational  status  of  nursing  as  compared  with  other  pro- 
fessions. Economic  difficulties  in  establishing  a  sound  basis 
for  nurses'  education.  Need  of  independent  endowments  for 
Training  Schools,  better  applicants,  higher  standards  of  edu- 
cation, suppression  of  commercial  and  inferior  schools.  What 
constitutes  a  good  school  of  nursing.  Development  of  univer- 
sity affiliations.  Work  of  Nursing  and  Health  Department  at 
Teachers  College,  Columbia  University  and  other  university 
courses,  Nurse's  responsibility  for  adding  to  her  own  efficiency 
and  increasing  the  general  fund  of  professional  knowledge. 
VII.  Nursing  Legislation 

Registration  of  nurses  through  legislative  enactments  as  a 
valuable  means  for  controlling  the  practice  of  nursing  and  the 
education  of  nurses.  History  of  the  registration  movement  in 
America.  Essentials  of  a  good  bill,  and  measures  for  its 
enactment.  Present  status  of  nursing  legislation  in  different 
states. 
VIII.  Nursing  Organizations  (general  and  alumnae) 

What  organization  has  done  for  nurses.  Essential  elements 
in  any  organization.  Types  of  nursing  organizations.  Aims 
and  activities  of  the  alumnae.  Duties  of  nurses  toward  pro- 
fessional organizations.  Elements  of  organization  and  parlia- 
mentary procedure  for  use  in  nursing  organizations. 


142  OUTLINES   OF  SUBJECTS 

IX.  National  Nursing  Organizations  and  Publications 

Development,  main  activities  and  general  plan  of  the  Ameri- 
can Nurses  Association,  League  of  Nursing  Education  and  Na- 
tional Organization  of  Public  Health  Nursing.  State  and 
local  branches.  Publications  and  reports.  The  nursing  press 
— American  Journal  of  Nursing,  Public  Health  Nursing  Quar- 
terly, and  other  publications.  Dangers  in  commercialization 
of  nursing  publications. 
X.  International  Relationships 

Origin,  aims,  and  activities  of  the  International  Council  of 
Nurses.  Brief  survey  of  countries  represented,  noting  general 
hospital  and  nursing  situation,  social,  educational  and  eco- 
nomic status  of  nurses,  leading  women  and  publications.  Atti- 
tude toward  nurses  of  other  countries.  Means  for  the  promo- 
tion of  friendly  and  helpful  relationships  with  other  countries. 
Opportunities  for  assisting  in  the  development  of  nursing  in 
backward  countries. 

METHODS  OF  TEACHING 

1.  Use   the   discussion   method   as   far   as   possible.     Have 
pupils   read   short   papers,    prepare  bibliographies,  and  bring 
problems   to   class   for  discussion.     The   case  method   can  be 
used  to  advantage  in  many  of  these  topics,  basing  the  discussion 
on  actual  situations  that  have  occurrred. 

2.  Personal  conferences  with  pupils  are  found  to  be  very  help- 
ful in  this  course.     It  is  evident  that  more  time  is  needed  to 
deal  with  the  subject  in  any  adequate  way.    Many  additional 
topics  could  be  suggested  for  supplementary  work — such  as  a 
short  course  on  public  speaking  and  parliamentary  law.     It 
would  be  very  helpful  also  to  have  the  nurses  organize  a  jour- 
nal club  to  run  parallel  with  this  and  other  -courses  in  the 
senior  year.     A  few  important  journals  might  be  selected  and 
one  assigned  to  each  member  of  a  class  for  review.     Probably  a 
better  plan  is  to  assign  a  topic  to  each  pupil  and  have  her 
search  for  important  articles  on  that  topic.     Brief  reports  on 
these  articles  are  given,  and  filing  cards  with  name,  author, 
reference  and  annotations  are  filed  for  the  use  of  the  club  mem- 
bers.    Students  should  be  encouraged  to  use  discrimination 
in  the  selection  of  articles  and  to  give  the  gist  of  the  contents 
only  in  the  report.    Time  should  be  left  for  discussion. 

ILLUSTRATIVE  MATERIAL 

Journals,  books,  photographs,  charts,  etc. 
REFERENCE  BOOKS 

Nutting  and  Dock:  History  of  Nursing,  vols.  I -IV. 

Nutting:  Educational  Status  of  Nursing  (published  by  Bureau 
of  Education,  Washington). 

Robb:  Nursing  Ethics. 


MODERN   SOCIAL  CONDITIONS  143 

Robb:  Educational  Standards. 

Nightingale:  Notes  on  Nursing. 

Osier:  An  Alabama  Student  and  other  Essays. 

Osier:  Aequanimitas. 

Paget:  Confessio  Medici. 

Parsons:  Nursing  Problems  and  Obligations. 

Reports  of  National  League  of  Nursing  Education. 

Reports  of  International  Council  of  Nurses. 

American  Journal  of  Nursing. 

Public  Health  Nurse  Quarterly. 

Nurse's  Journal  of  the  Pacific  Coast. 

Canadian  Nurse. 

British  Journal  of  Nursing. 

Modern  Hospital,  etc. 

See  also  books  on  History  of  Nursing,  Nursing  Ethics,  Mod- 
ern Social  Problems,  etc. 

Modern  Social  Conditions 

TIME  :  10  hours,  to  be  given  by  authorities  on  the  various  topics  outlined, 
or  by  an  expert  in  Social  Economy  or  Social  Science.  Given 
in  the  latter  part  of  the  third  year. 

OBJECTS  OP  THE  COUESE 

1.  To  give  the  pupil  a  general  understanding  of  the  broad 
fundamental  problems  inherent  in  society  today,  showing  the 
methods  of  approach  and  the  agencies  at  work  in  attempting 
to  solve  these  problems. 

2.  To  make  the  nurses  sufficiently  familiar  with  the  present 
emphasis  in  methods  of  social  work  so  that  they  will  have  some 
basis  for  further  reading  and  study,  also  to  serve  as  a  back- 
ground for  public  health  nursing  and  other  forms  of  social  work. 

3.  To    further   emphasize    the    close    relationship    between 
health  and  social  problems. 


I.  Poverty  and  Philanthropy 

Brief  historical  sketch  of  the  development  of  society,  show- 
ing how  as  the  organization  of  society  became  more  complicated 
the  emphasis  shifted  from  the  individual  to  the  group.  In 
philanthropy  this  meant  organized  scientific  treatment  of  social 
problems,  rather  than  the  spasmodic  efforts  of  benevolent  in- 
dividuals. Present  tendency  toward  governmental  action — 
federal  children's  bureau,  state,  country  and  local  public  health 
agencies,  state  employment  agencies,  social  legislation,  etc. 
Change  in  conception  of  poverty — no  longer  considered  dis- 
tinct from  other  problems,  but  rather  the  result  of  them  and 
must  be  attacked  through  them.  Treatment  of  poverty  insep- 
arable from  treatment  of  all  the  various  social  ills — unnecessary 


144  OUTLINES   OF   SUBJECTS 

sickness,    dependency,   feeble-mindedness,   insanity,    physical 
or  mental  degeneracy,  physical  handicaps,  insufficient  wages, 
unemployment,  etc. 
II.  Delinquency  and  Crime 

Causes  of  delinquency1 — hereditary  and  environmental.  De- 
fectives1— diagnosis  and  treatment;  psychological  and  mental 
clinics,  tests;  ungraded  classes,  segregation  in  institutions 
with  special  occupation  training.  Close  relation  between  men- 
tal diseases  and  delinquency.  Special  problem  of  juvenile 
delinquency.  Treatment- — proper  recreation,  schools  adapted 
to  the  needs  of  the  individual,  socializing  court  action,  proba- 
tion officers,  prison  reform,  making  correctional  institutions 
stand'for  the  highest  development  of  the  individual  rather  than 
the  punishment  of  offense,  the  indeterminate  sentence. 

III.  Education  and  Recreation 

Modern  conception  of  education  and  recreation.  Schools  to 
be  the  center  and  guide  in  all  activities,  mental,  physical  and 
social,  assisting  each  child  to  develop  his  highest  potentialities 
along  these  various  lines.  Vocational  guidance  through  schools 
The  industrial  school.  Recognition  of  the  importance  of  play 
for  normal  development.  Natural  desire  for  play  when  mis- 
directed may  lead  to  delinquency  and  immorality — gangs,  gam- 
bling, dance  halls,  etc.  Boys  and  girls  clubs1 — Boy  Scouts, 
Girl  Scouts,  Junior  Police,  etc. 

IV.  Social  Hygiene 

The  far  reaching  effects  of  the  sex  instinct.  Individual  and 
social  ills  that  come  through  lack  of  understanding  and  mis- 
use. Mental  and  physical  diseases,  immorality,  prostitution 
and  illegitimacy.  Desirability  of  frank  intelligent  conception 
of  the  significance  and  proper  place  of  the  sex  instinct.  Sex 
education — how  and  by  whom  to  be  given.  The  problem  of 
prostitution  and  agencies  for  its  control  and  prevention. 
V.  Alcohol  and  Drugs 

The  problem  of  alcohol  and  drugs  in  relation  to  poverty, 
unemployment,  crime,  prostitution,  insanity  and  other  social 
and  health  problems.  History  of  the  movement  for  the  con- 
trol of  alcoholism.  Scientific  investigations  into  effects  of 
alcohol  and  their  results.  Causes  and  effects  of  the  drug  habit. 
Methods  of  handling  cases  and  preventing  sale  of  drugs. 
VI.  Modern  Industry 

Brief  survey  of  some  modern  industrial  problems.  Unem- 
ployment. Women  and  children  in  industry.  Labor  organi- 
zations both  for  employer  and  employee.  Use  of  the  strike. 
The  protocol  and  boards  of  arbitration.  Tendency  toward 
governmental  control  of  industry  in  the  interest  of  common 
welfare.  Labor  legislation — regulating  hours,  minimum  wage, 
child  labor,  working  men's  compensation. 


MODERN   SOCIAL  CONDITIONS  145 

VII.  Immigration  and  Race  Problems 

Causes  of  emigration  from  other  countries.  Dominant  race 
traits  and  social  backgrounds.  Problems  of  assimilation. 
Influences  which  stimulate  and  retard  adjustment  and  develop- 
ment. Direct  efforts  toward  safe-guarding  the  immigrant. 
Relation  of  the  immigrant  to  industrial  problems. 
VIII,  IX  and  X.  Agencies  and  Methods  for  Relief  and  Prevention 

General  principles  of  case  work — family  the  unit.  Social 
diagnosis  and  treatment  with  special  factors  to  be  considered. 
Relief  agencies' — use  of  relief  as  social  treatment.  Society 
for  Organizing  Charity,  etc.  Children's  agencies — Children's 
Aid  Society,  Society  for  the  Prevention  of  Cruelty  to  Children, 
etc.  Specialized  agencies' — for  wayward  girls,  for  mental  cases, 
for  court  cases,  etc.  Value  of  social  records  and  social  sta- 
tistics— their  interpretation.  Methods  of  education  and 
publicity.  Mass  methods' — settlements,  social  centers,  play- 
grounds, etc.  Value  of  schools,  churches,  theaters,  the  press, 
etc.,  as  social  agencies.  Social  legislation.  Work  of  the  Con-* 
sumer's  League;  Child  Labor  Committee,  etc.  Labor  Legis- 
lation. Social  Insurance.  Old  Age  and  Widow's  Pensions. 

METHODS  OF  TEACHING 

1.  Lectures  and  reference  reading,  followed  by  class  discus- 
sion or  conference,  if  possible,  with  the  lecturer,  or  by  the 
Head  of  the  Social  Service  Department  or  someone  actively 
engaged  in  social  work. 

2.  The  lectures  must  necessarily  be  sketchy  in  character, 
giving  but  a  bird's  eye  view  of  the  subject  and  should  be  given 
in  simple  non-technical  terms. 

3.  Excursions  should  be  made,  if  at  all  possible,  to  the  in- 
stitutions and  agencies  dealing  with  these  particular  problems 
in  the  community. 

4.  The  assignment  of  reading  is  most  important,  as  this  should 
supplement  the  necessarily  limited  ground  covered  by  the 
lectures.    As  the  time  usually  available  is  very  limited  assign- 
ments should  be  brief  and  very  carefully  selected. 

TEXT  AND  REFERENCE  BOOKS 

Ellis:  Task  of  Social  Hygiene. 

Devine:  The  Normal  Life. 

Addams:  Democracy  and  Social  Ethics. 

Streightoff :  Standards  of  Living. 

Hunter:  Poverty. 

Devine:  Misery  and  its  Causes. 

Devine:  Principles  of  Relief. 

Henderson:  Dependents,  Defectives  and  Delinquents. 

Healy:  The  Individual  Delinquent. 

Loch:  Charity  and  Social  Life. 


146  OUTLINES   OF   SUBJECTS 

Publications  of  the  New  York  State  Committee  on  Mental 
Hygiene. 

Addams:  The  Spirit  of  Youth  and  the  City  Streets. 

Lee:  Play  in  Education. 

Abbott:  Women  in  Industry. 

Richmond,   Mary:  Social   Diagnosis.     Russell    Sage   Founda- 
tion. 

Schreiner:  Woman  and  Labor. 

Publications  of  the  American  Association  for  Labor  Legislation. 

Antin:  The  Promised  Land. 

Steiner:  Ebb  and  Flow  of  the  Immigrant  Tide. 

Zangwill:  The  Melting  Pot. 

Devine:  The  Spirit  of  Social  Work. 

Cabot:  Social  Service  and  the  Art  of  Healing. 

Addams:  Twenty  Years  at  Hull  House. 

Addams:  A  New  Conscience  and  an  Ancient  Evil. 

Wald:  The  House  on  Henry  Street. 

Seager:  Social  Insurance. 

Proceedings    of    the    National    Conferences    of  Charities  and 
Corrections. 

The  Survey. 

See  also  under  History  of  Nursing,  Survey  of  the  Nursing  Field, 

etc. 

NOTE' — Lectures  devoted  to  the  social  aspects  of  special  classes  of  dis- 
ease, will  be  found  under  such  subjects  as  Obstetrical  Nurs- 
ing, Children's  Diseases,  Communicable  Diseases,  etc.  If  not 

covered  in  this  way,   such  topics  might  be  included  under 

Modern  Social  Conditions. 


G.  SPECIAL  BRANCHES  OF  NURSING 

Introduction  to  Institutional  Work  (Elective) 

TIME:  10  hours.  Classes  and  conferences  conducted  by  the  principal 
of  the  training  school.  Course  to  be  given  in  latter  part  of 
third  year. 

OBJECTS  OF  COURSE 

To  give  the  student  a  better  understanding  of  some  of  the 
problems  and  responsibilities  of  the  supervisors  and  head 
nurses  in  charge  of  various  hospital  departments.  The  course 
is  intended  for  students  who  have  shown  special  ability  along 
executive  lines,  and  who  intend  to  continue  in  hospital  work. 

No  attempt  should  be  made  to  deal  with  the  larger  and  more 
responsible  duties  which  belong  to  hospital  and  training  school 
administration. 

OUTLINE  OF  CLASSES 

I.  Hospital  Organization 

Different  types — municipal,  state,  private,  semi-private. 
Study  of  general  plan  of  organization  in  hospital.  The  ward 
as  a  hospital  in  miniature — needs  of  ward  as  sample  of  needs 
of  hospital  as  a  whole.  Relation  of  ward  to  other  departments 
of  hospital — kitchen,  laundry,  linen  and  supply  rooms,  phar- 
macy, social  service  department,  training  school,  admitting 
department,  general  office,  etc. 
II.  Ward  Planning  and  Equipment 

The  planning  of  wards  and  accessory  rooms;  size  and  arrange- 
ment for  convenience  in  work ;  finish  and  structural  equipment. 
Standard  hospital  furnishings.  Average  allowance  of  linen, 
utensils,  etc.,  per  patient.  Standardization  of  equipment 
for  different  types  of  work.  Consideration  of  use,  cost,  special 
advantages,  durability,  sanitary  features,  etc.  Economy  in 
use  of  equipment  and  supplies.  Care  and  renewal  of  supplies. 
Methods  of  exchange.  Responsibility  for  medical  and  surgical 
supplies  on  wards.  Methods  of  purchase — contract,  open 
market. 
III.  Ward  Personnel  and  its  Organization 

Responsibility  of  head  nurse  for  ethical  atmosphere.  Influ- 
ence of  her  personality  in  developing  esprit  de  corps  of  the  ward. 
The  head  nurse  as  a  judge  of  character.  Especial  responsi- 
bility toward  the  new  probationers.  Relation  of  head  nurse 
to  visiting  staff,  house  staff  and  nurses,  students  and  employees. 
Arrangement  of  ward  services,  hours  of  work  for  nurses,  off- 
duty  time,  etc.  Reasons  for  the  eight-hour  day  and  various 
systems  of  carrying  on  ward  work  on  this  basis.  The  night 
nurse  and  her  special  problems.  Special  nurses — hours  of 

147 


148  OUTLINES   OF   SUBJECTS 

work,  relief,  etc.  Relation  of  head  nurse  to  maids  and  order- 
lies— interest  in  their  hours  of  work,  living  conditions,  recrea- 
tion, etc. 

IV.  The  Head  Nurse  and  the  Patients 

Purpose  of  hospital — care  and  comfort  of  patients.  The 
rights  and  obligations  of  patients  in  a  hospital.  Reception  of 
patients — first  impressions.  Hospital  noises' — how  to  mini- 
mize. Respect  for  religious  and  racial  differences  and  peculiar- 
ities. Opportunities  for  social  service.  Some  principles  of 
psychology  used  in  the  handling  of  patients.  Occupations  for 
ward  patients.  Relation  of  head  nurse  to  patients'  friends. 
Attitude  and  support  of  community  influenced  largely  by  per- 
sonal care  and  consideration  of  patients  and  attitude  toward 
their  friends  and  relatives.  Care  of  patients'  clothing  and 
property. 
V.  The  Head  Nurse  as  an  Executive 

Some  principles  of  good  management — collectiveness  and 
cooperation.  Capacity  for  leadership — how  developed.  Dan- 
gers of  arbitrary  leadership.  Staff  and  line  functions.  Rela- 
tion of  head  nurse  to  other  hospital  departments.  Assignment 
of  work.  Value  of  schedules.  Delegation  of  responsibility. 
Discipline — its  meaning  and  purpose.  Test  of  ability  for 
executive  work.  Opportunity  for  individual  development. 

VI.  The  Head  Nurse  as  a  Teacher 

Teaching  functions  of  the  head  nurse — what  they  involve. 
Value  of  bedside  teaching.  Supervision  and  constructive  crit- 
icism of  work,  done  by  nurses.  Perfection  of  technique, 
standardization  of  work,  motion  study.  Need  of  keeping  in 
touch  with  theoretical  teaching  given  to  nurses.  Cooperation 
with  instructor  of  nurses.  Head  nurse  as  teacher  of  applied 
hygiene  and  sanitation  to  patients  and  public.  Head  nurse  as 
teacher  of  ward  maids  and  orderlies  in  methods  of  house  work, 
care  of  cleaning  utensils,  cleaning  process  and  agents,  etc. 
VII.  Ward  Housekeeping 

Review  of  general  principles  of  household  economics.  Estab- 
lishment of  standards.  Inventories.  Stock-taking.  Repairs 
and  renewals.  Disposal  of  garbage  and  waste.  Prevention  of 
pests.  Supervision  of  maids  and  orderlies.  Schedules  of  work 
—daily  and  weekly  cleaning.  Care  of  diet  kitchen,  refrigera- 
tors, etc.  Care  of  lavatories.  Private  rooms  and  their  care. 
Surgical  dressing  rooms,  service  rooms,  balconies,  etc. 
VIII.  The  Patient's  Food 

Food — its  preservation,  preparation  and  service.  Dietaries 
for  ward  and  private  patients — need  of  personal  supervision 
of  head  nurse.  Special  diets— caloric  feeding,  etc.  Feeding 
helpless  patients.  Prevention  of  waste.  Diet  sheets  and 
their  importance.  Care  of  food  trucks.  Question  of  allowing 
food  to  be  brought  to  patients  by  their  friends.  Problems  in 


INTRODUCTION   TO   PRIVATE   NURSING  149 

relation  to  racial  and  personal  preferences  in  diet,  religious 
observances,  etc. 
IX.  Records  and  Record  Keeping 

Value  of  records  and  their  functions — to  hospital  adminis- 
tration— to  medical  staff — for  protection  of  nurse.  Card  in- 
dex system.  Hospital  cost  accounting.  Ward  inventory. 
Daily  reports,  charts,  orders,  etc.  Necessity  for  scientific 
accuracy,  judgment,  neatness.  Honesty  in  record-keeping  as 
test  of  character. 
X.  Special  Problems  in  Ward  Management 

Application  of  foregoing  principles  to  work  in  various  de- 
partments— medical,  surgical,  obstetrical,  children's  operat- 
ing room,  dispensary^  etc.  Opportunities  for  continued  edu- 
cation and  training  of  the  nurse  in  the  hospital.  Dangers  of 
too  narrow  specialization,  and  the  institutional  point-of-view. 
Importance  of  outside  interests  and  diversions,  and  a  whole- 
some and  normal  social  life.  Opportunities  for  advancement 
open  to  head  nurses  and  supervisors.  Importance  of  constant 
study  and  self-improvement  through  reading,  journal  clubs, 
visiting  other  institutions,  etc. 

NOTE:  If  not  given  as  part  of  the  regular  nurses'  training  it 
is  suggested  that  the  above  outline  might  serve  as  a  suggestive 
basis  for  head  nurses'  conferences. 

METHODS  OF  TEACHING 

A  course  of  this  kind  will  usually  take  the  form  of  a  more  or 
less  informal  class  discussion.  The  idea  is  to  have  the  stu- 
dents assisting  head  nurses  in  some  of  the  departments  of  the 
hospital  where  they  will  be  in  close  touch  with  many  of  the 
problems  under  discussion.  Individual  problems  may  be 
assigned  for  investigation  and  reported  on  in  class. 

TEXT  AND  REFERENCE  BOOKS 

Palmer:  The  Teacher. 

James:  Talks  to  Teachers. 

Taylor:  Shop  Management. 

Pillsbury:  Essentials  of  Psychology. 

Nutting:  Educational  Status  of  Nursing. 

Robb:  Nursing  Ethics. 

Robb:  Educational  Problems. 

Parsons:  Nursing  Problems  and  Obligations. 

Cannon:  Hospital  Social  Service. 

Standard  Curriculum  for  Nursing  Schools. 

Articles  in  The  American  Journal  of  Nursing,  Journal  of 
Home  Economics,  The  Modern  Hospital,  etc. 

Introduction  to  Private  Nursing  (Elective) 

TIME:  10  hours.    Class  work,  discussions  and  demonstrations  conducted 
by  a  member  of  the  staff  who  has  had  experience  in  private 


150  OUTLINES   OF  SUBJECTS 

nursing,  or  by  a  specially  qualified  private  nurse.     To  be  given 
in  the  latter  half  of  the  third  year. 

OBJECTS  OF  THE  COURSE 

To  discuss  in  detail  the  more  important  problems  which 
confront  the  nurse  in  private  duty,  and  to  establish  the  underly- 
ing principles  of  successful  private  nursing  and  suggest  modi- 
fications or  adaptations  of  hospital  technic  which  may  be  re- 
quired in  this  work.  The  course  is  intended  only  for  those 
students  who  expect  to  go  into  the  private  nursing  field. 

OUTLINE  OF  CLASSES 

I.  Essentials  to  Success  in  Private  Duty 

Considerations  which  would  determine  the  choice  of  this 
branch  of  work.  Demands  on  health — need  of  special  atten- 
tion to  rest,  exercise,  food,  etc.  Requirements  as  to  personality 
and  character.  Professional  requirements — special  kinds  of 
skill,  intelligence  and  efficiency  required.  Social  requirements 
— knowledge  of  social  customs  and  observances  which  make 
one  at  home  in  good  society.  Companionship — resourceful- 
ness in  providing  diversion  and  entertainment  for  patients 
when  necessary.  Educational  functions  of  the  private  nurse. 
Opportunities  for  teaching  and  influencing  homes  and  com- 
munities. 
II.  Establishing  One's  Self  in  Private  Practice 

Where  to  locate?  The  relative  advantages  of  larger  and 
smaller  centers.  Special  needs  of  the  small  town.  Impor- 
tance of  joining  a  good  registry.  Rules  of  the  registry.  The 
responsibility  of  the  private  nurse  for  the  care  of  sick  patients 
of  all  types  and  conditions.  The  ethics  of  picking  and  choosing 
among  cases.  General  nursing  versus  specialization  in  private 
nursing.  How  to  get  in  touch  with  physicians  and  hospitals. 
Engagements  and  charges.  Identification  with  local  nursing 
interests.  Relationship  with  nurses  from  different  schools, 
practical  nurses  and  attendants. 
III.  Living  Conditions  and  Expenditures 

The  private  nurse's  income — proportion  to  be  devoted  to 
professional  and  personal  expenses.  Requirements  in  clothing. 
Recommendations  as  to  uniforms,  street  clothes,  clothes  for 
night  duty,  shoes,  etc.  Equipment  required  for  general,  spe- 
cial, hospital  and  country  cases.  The  contents  and  packing  of 
the  private  nurse's  suit  case.  Problems  of  living.  Choice  of 
a  room  and  provision  for  meals  when  off  duty.  The  relative 
advantages  of  the  nurses'  club,  cooperative  housekeeping  and 
boarding.  Importance  of  good  telephone  service.  Laundry 
problems.  Proportion  of  income  to  be  spent  on  recreation  and 
personal  improvement.  Importance  of  the  savings  fund  and 


INTRODUCTION  TO   PRIVATE  NURSING  151 

insurance  as  investments.     (Demonstrate  proper  costume  for 
private  nurse — out-door  and  in-door;  also  private  nurse's  suit- 
case with  outfit.) 
IV.  The  Nurse  in  the  Home 

The  position  of  the  nurse  in  the  family.  Relationship  to 
the  patient,  the  members  of  the  family,  servants  and  visitors. 
Looking  at  things  from  others'  point  of  view.  How  to  secure 
the  assistance  and  cooperation  of  the  patient  and  family.  The 
choice,  arrangement  and  care  of  the  sick  room.  The  ordering 
and  serving  of  meals.  Preparation  of  special  diets  in  the  home. 
Economy  in  sick-room  supplies.  How  to  improvise  equipment. 
Adaptation  of  treatment  with  limited  equipment.  The  im- 
portance of  records.  The  daily  routine  in  ordinary  cases. 
V.  Special  Duty  in  the  Hospital 

Conditions  of  special  duty  in  various  types  of  hospitals. 
Customary  regulations  concerning  hours,  relief,  room,  board, 
remuneration,  etc.  Relation  of  the  special  nurse  to  the  offi- 
cers of  the  hospital  and  training  school,  visiting  and  resident 
physicians,  pupil  nurses,  ward-maids  and  orderlies,  and  other 
special  nurses.  Duties  of  the  special  nurse  on  ward  or  private 
cases.  Reportls  and  records.  The  use  of  hospital  supplies. 
Night  work  in  the  hospitial.  Cooperation  of  nurses  on  the  same 
case. 
VI.  Hotel  Life  and  Travelling 

Special  difficulties  presented  by  hotel  life.  Problems  of  uni- 
form, meals,  relief,  etc.  Relationship  of  the  nurse  to  hotel 
management,  staff  and  guests.  Preparation  for  travelling  at 
home  and  abroad.  Requirements  and  conveniences  for  both 
patient  and  nurse.  How  to  pack  a  trunk  and  attend  to  bag- 
gage. Management  of  the  journey.  Arrangements  for  meals, 
transportation  at  station,  etc.  What  to  do  for  train-sickness 
and  sea-sickness.  Special  points  in  travelling  with  a  baby,  a 
male  patient,  a  bed-patient,  an  insane  or  nervous  patient,  etc. 
(Demonstration  of  packing  a  trunk  might  be  given  by  an 
expert.) 
VII.  Private  Duty  in  the  County  and  under  Pioneer  Conditions 

Typical  cases  in  camps,  isolated  districts  and  country  com- 
munities. Conditions  which  have  to  be  met  in  the  country. 
Necessity  of  understanding  people  and  their  ways.  Arrange- 
ments as  to  food,  supplies,  relief,  etc.  Responsibilities  which 
rest  on  the  nurse  in  the  absence  of  the  doctor.  Disposal  of 
excreta  and  other  sanitary  precautions  in  the  country. 
VIII.  Special  Problems  in  Obstetrical  and  Surgical  Cases 

Preparation  for  confinement  in  a  private  house,  especially  in 
an  emergency  case.  The  care  and  training  of  the  baby.  Pre- 
paring feedings  in  the  home.  The  surgical  case.  Preparation 
for  operations  and  surgical  dressings  in  the  home.  Methods  of 
sterilizing  under  home  conditions. 


152  OUTLINES   OF  SUBJECTS 

IX  and  X.  Special  Problems  in  Medical  Cases  and  Emergencies 

The  contagious  case.  Technic  of  isolation  in  private  homes. 
Rules  for  the  nurse  after  caring  for  different  types  of  infection. 
The  care  of  sick  children  of  different  ages — management  dur- 
ing convalescence.  The  chronic  case — special  demands  on  the 
nurse  in  long  continued  cases,  such  as  paralysis,  tuberculosis, 
heart  disease,  etc.  The  care  of  the  aged.  Nursing  mental 
and  nervous  patients.  Special  problems  involved  in  caring  for 
male  patients — avoidance  of  compromising  situations.  What 
to  do  about  special  forms  of  treatment  for  male  patients.  What 
to  do  in  case  of  death — in  private  house,  hospital,  or  when 
travelling. 

METHODS  OF  TEACHING 

1.  Class  work  should  be  conducted  largely  by  means  of  dis- 
cussion.   Problems  and  cases  should  be  suggested  and  pupils 
encouraged  to  work  them  out  and  report  on  them. 

2.  If  possible  each  pupil  who  expects  to  do  private  nursing 
should  spend  a  limited  time  in  the  care  of  special  patients  in 
the  hospital,  preferably  in  general  wards.    This  should  cover 
a  variety  of  cases  and  should  not  be  extended  over  a  period 
of  more  than  a  few  weeks.     The  class  work  should  be  con- 
nected as  closely  as  possible  with  this  practical  work. 

ILLUSTRATIVE  MATERIAL  AND  EQUIPMENT 

Articles  and  photographs  illustrating  the  subject. 
TEXT  AND  REFERENCE  BOOKS 

De  Witt:  Private  Duty  Nursing. 

Lounsbury:  Making  Good  on  Private  Duty. 

Nightingale:  Notes  on  Nursing. 

Robb:  Nursing  Ethics. 

Parsons:  Nursing  Problems  and  Obligations. 

Back  files  of  the  American  Journal  of  Nursing,    and   other 
periodicals. 

Introduction  to  Public  Health  Nursing  and  Social  Service  (Elective) 

TIME:  10  hours.  Conducted  by  the  head  of  the  social  service  depart- 
ment, the  superintendent  of  the  visiting  nurse  society  or  special 
teacher  of  this  subject.  Given  in  the  latter  part  of  third  year. 

OBJECTS  OF  THE  COURSE 

1.  To  give  the  pupil  nurse  a  theoretical  background  for  the 
field  work  which  she  is  receiving,  so  she  may  understand  the 
significance  and  importance  of  the  various  problems  met  in 
practical  work  whether  it  is  visiting  nursing  or  hospital  social 
service  work. 

2.  To  teach  her  something  of  the  technique  and  procedure 
to  be  followed  in  this  type  of  work,  so  that  she  may  be  ready 


INTRODUCTION   TO    PUBLIC    HEALTH   NURSING  153 

on  leaving  the  training  school  to  enter  one  of  the  commoner 
fields  of  public  health  nursing  as  a  useful  staff  worker,  with 
some  general  idea  of  case  work  and  routine  visiting  in  families, 
and  with  some  vision  of  the  ideals  toward  which  she  should 
aim  in  the  further  development  of  such  work. 

OUTLINE  OF  CLASSES 
I  and  II.  Introduction 

Brief  history  of  the  development  of  visiting  nursing.  De- 
fine purpose  and  principles  which  underlie  public  health  nurs- 
ing organizations' — by  whom  organized,  how  supported  and 
governed,  what  elements  the  Board  represents,  committees 
and  their  functions,  etc.  Function  and  scope  of  work — care  of 
the  sick,  prevention  of  disease,  constructive  social  case  work. 
Relation  to  the  hospital,  to  doctors,  to  municipal,  philan- 
thropic, medical  and  social  agencies,  to  the  community  and  to 
the  patient. 

III.  Theory  and  Technique  of  Case  Work 

Meaning  of  social  diagnosis  and  social  treatment.  Empha- 
sis on  family  treatment.  Factors  to  be  considered  in  all  case 
work — mental  and  physical  heredity,  family  influences,  educa- 
tion and  training,  occupation,  income,  recreation.  The  rela- 
tion of  these  factors  to  health.  Importance  of  first  interview 
and  first  home  visit. 

IV.  Source  of  Cases  and  Basis  of  Selection 

Cases  sent  by  doctors,  nurses,  private  individuals,  organiza- 
tion (business,  religious  and  philanthropic,)  social  service 
workers,  and  other  patients.  Methods  of  referring — details. 
Various  bases  of  selection  in  hospital  social  service  and  visiting 
nursing. 
V  and  VI.  Case  Work  in  Visiting  Nursing 

Freely  illustrated  from  case  histories,  showing  exact  pro- 
cedure and  methods  in  treatment  from  the  first  step  after  case 
is  referred  to  the  last  step  when  case  is  terminated.  Home  nurs- 
ing technique  in  various  diseases.  The  nurse's  bag — its  equip- 
ment and  care.  Special  nursing  and  social  problems  presented 
by  acute,  chronic  and  contagious  cases  when  cared  for  in  the 
the  home.  Care  of  children  in  home  vs.  hospital  care. 

VII.  Case  Work  in  Hospital  Social  Service 

Types  of  cases  especially  requiring  medico-social  treatment. 
Enlarge  upon  social  causes  and  social  results  in  each  instance. 
Medical — tuberculosis,  cardiac,  stomach,  diabetes.  Obstetri- 
cal— prenatal  and  sex  problems.  Pediatrics — feeding  cases, 
instruction  in  care  of  children.  Orthopedic.  Mental  and 
nervous.  Venereal  diseases.  Illustrate  from  case  histories. 

VIII.  Office  Methods 

Records — importance  and  purpose.  Study  of  record  sheets 
and  history  taking.  Resource  catalogue  and  other  devices 
making  for  greater  efficiency  and  time  saving. 


154  OUTLINES    OF   SUBJECTS 

IX  and  X.  Modern  Tendencies  and  Special  Problems 

Hospital  social  service — shall  relief  be  given  by  social  serv- 
ice department?  Limitation  of  intake  of  work,  preventive 
work,  community  work.  Use  of  voluntary  workers.  Visit- 
ing nursing — hourly  nursing,  generalization  versus  specializa- 
tion, relief-giving,  the  visiting  housekeeper  and  attendant 
service  in  connection  with  Visiting  Nurse  Association.  Pos- 
sibilities of  dietary  work,  surveys,  focusing  on  new  problem 
each  year,  research.  Specialization  vs.  centralization  in  Pub- 
lic Health  Nursing.  Community  Centers. 

METHODS  OF  TEACHING 

1.  The  course  should  be  conducted  as  a  conference  rather 
than  a  lecture  course,  the  person  conducting  the  course  pre- 
senting her  material  first  but  allowing  questions  during  presen- 
tation and  always  leaving  time  for  free  discussion  afterwards. 

2.  There  should  be  constant  use  of  cases  seen  in  the  ward 
and   Social   Service   Department   or   Visiting   Nurse   Society. 
Each  nurse  might  be  assigned  a  particular  type  of  case  to- 
present  to  the  group  from  her  own  experience  either  in  the 
hospital  or  Social  Service  Department. 

3.  While  of  necessity  the  local  situation  must  figure  largely 
in  the  material  considered,  each  nurse  should  be  required  to- 
describe  the  work  done  in  some  other  city  as  discovered  through 
annual  reports,   correspondence,   etc.,   thus  bringing  out  the 
variety  of  development  possible  in  the  work  and  enlarging  the 
nurse's  knowledge  of  other  than  the  local  situation. 

4.  The  ground  covered  and  the  emphasis  on  different  topics 
will  necessarily  vary  widely.    The  above  outline  is  suggestive 
merely. 

ILLUSTRATIVE  MATERIAL 

Reports  of  various  Social  Service  Departments  and  Visit- 
ing Nurse  Societies.  Photographs,  posters,  exhibits,  etc. 

TEXT  AND  REFERENCE  BOOKS 

Gardner:  Public  Health  Nursing. 

Foley:  Visiting  Nurse  Manual. 

Wald:  The  House  on  Henry  Street. 

Cabot:  Social  Service  and  the  Art  of  Healing. 

Cannon:  Social  Service  in  Hospitals. 

Devine:  The  Normal  Life,  Misery  and  Its  Causes. 

Davis  &  Warner:  Dispensaries. 

The  Proceedings  of  the  National  Conference  of  Charities  and 

Corrections. 

Public  Health  Nurse  Quarterly. 

Publications  of  the  Russell  Sage  Foundation  on  Case  Work. 
Publications  of  the  State  and  City  Boards  of  Health. 

See  also  under  Modern  Social  Conditions,  Survey  of  the 
Nursing  Field,  etc. 


INTRODUCTION  TO  LABORATORY  WORK  155 

Introduction  to  Laboratory  Work  (Elective) 

TIME  :  10  hours.  Classes,  conferences  and  laboratory  work  conducted  by 
a  pathologist — an  elective  course  given  in  the  end  of  the  Senior 
year. 

OBJECTS  OF  COURSE 

1.  One  of  the  newer  branches  of  work  into  which  nurses  are 
going,  is  that  of  assistants  to  pathologists  in  hospital  and 
Board  of  Health  laboratories,  and  routine  pathological  work 
in  physicians'  offices.    The  short  course  here  outlined  would  not 
fit  a  nurse  to  assume  any  responsible  position  in  this  field,  but 
shouW  give  her  an  introduction  to  this  form  of  work,  and  if 
she  shows  unusual  ability  and  interest  in  it,  would  probably 
lead  to  further  specialization  after  graduation, 

2.  Such  a  course  would  aim  to  give  a  greater  facility  in  such 
tests  as  may  be  required  in  any  branch  of  nursing  work  (for 
example  simple  urinal ysis),  would  make  nurses  more  observ- 
ant of  abnormal  conditions  in  their  more  responsible  work  with 
patients  outside  the  hospital,  and  would  make  them  more  in- 
telligent and  efficient  assistants  in  all  forms  of  experimental 
and  clinical  work. 

OUTLINE  OF  CLASSES 
I.  Introduction 

Equipment,     solutions,     reagents.     Laboratory    rules     and 
methods. 
II,  III,  and 

IV.  Urinalysis 

Routine     tests.    Urinary     sediments.    Quantitative     tests. 
Relation  to  diets.    Charting. 
V.  Feces 

Routine  tests.     Parasites  and  Ova.     Charting.     Diets. 
VI.  Stomach  Contents 

Macroscopic  and  microscopic  examination.    Qualitative  and 
quantitative  tests.    Charting. 
VII.  Sputum 

Macroscopic  and  microscopic  examination.     Carbol-fuchsin 
and  Gram's  stains.    Charting. 
VIII  and  IX.  Blood 

Hemoglobin;  counting  corpuscles;  smears,  differential  count- 
ing.   Blood  cultures,  blood  pressure. 
X.  Body  fluids 

Transudates  and  exudates.    Routine  tests.    Smears. 

METHODS  OF  TEACHING 

1.  The  greatest  part  of  the  course  would  be  taught  to  small 
groups  by  the  demonstration  and  laboratory  method.  Stu- 
dents who  take  this  work  should  have  a  period  of  practical  ex- 


156  OUTLINES   OF  SUBJECTS 

pericnce  in  the  pathological  laboratory,  of  from  one  to  two 
months,  where  they  would  be  under  the  direct  supervision  of 
the  pathologist.  Conferences  and  short  papers  will  help  in 
mastering  the  principles  and  readings  should  be  assigned  in 
current  journals  and  reference  books. 

NOTE:  In  hospitals  where  special  dietary  investigation  and 
experimentation  is  being  carried  on,  selected  senior  pupils  may 
be  assigned  to  this  form  of  laboratory  service.  In  such  a  case 
the  course  of  study  would  deal  with  nutritional  principles  and 
technic  instead  of  the  above.  Nurses  especially  trained  in  this 
branch  of  work  are  beginning  to  be  in  some  demand.  In  Board 
of  Health  work,  the  routine  examination  of  water  and  milk 
would  be  an  important  part  of  an  assistant's  duties. 

EQUIPMENT  AND  ILLUSTRATIVE  MATERIAL 

Laboratory      equipment — slides,      pathological   specimens 
charts,  etc. 

TEXT  AND  REFERENCE  BOOKS 

Gibson:  Chemical  Laboratory  Technic  for  Nurses. 

Wells:  Chemical  Pathology. 

Delafield  and  Prudden:  Pathology. 

Adami:  Pathology. 

Wood:  Chemical  and  Microscopical  Diagnosis. 

See  also  under  Pathology,  Bacteriology,  Medicine,  etc. 


APPENDIX  I 

Bibliography 

The  following  list  of  books  includes  all  those  mentioned  in  the  preceding 
pages,  with  publishers,  prices  and  dates  of  publication.  It  is  suggested 
that  this  list  be  used  as  a  basis  of  selection  for  the  Training  School 
Library. 

Abbott,  Grace:  Women  in  Industry.    Appleton.     1910.    $2.50. 

Adami,  J.  G.,  M.D.  and  Macrae,  John,  M.D.:  Text  Book  on  Pathology.    Lea 

&  Febriger.     1914.    $5.00. 
Addams,  Jane:  A  New  Conscience  and  an  Ancient  Evil.    Macmillan.    1912. 

$1.00. 

Addams,  Jane:  Social  Ethics.    Macmillan.     1902.    $1.25. 
Addams,  Jane:  The  Spirit  of  Youth  and  the  City  Streets.    Macmillan.     1909. 

$1.25. 

Addams,  Jane:  Twenty  Years  at  Hull  House.    Macmillan.     1910.    $2.00. 
Amoss,  H.  L.,  M.D. :  Chemistry  for  Nurses.    Lea  &  Febriger.     1915.    $1.50. 
Antin,  Mary:  The  Promised  Land.    Houghton-Mifflin.     1912.    $2.00. 
Asher,   Phillip,   M.D.:  Chemistry  and  Toxicology  for   Nurses.    Saunders. 

1918.    $1.50. 

Bacon,  Gorham,  M.D.:  Manual  of  Otology.     Lea  &  Febriger.     1909.    $2.25. 
Balderston,  L.  Ray:  Laundry  Manual.     (Authors  own  publication.)     1914. 

$1.25. 

Balderston,  L.  Ray:  Housewifery.     Lippincott.     1919.    $2.00. 
Bancroft,  Jessie  H. :  Posture  of  School  Children.    Macmillan.     1913.    $1.50. 
Barrows  and  Lincoln:  Home  Science  Cook  Book.    Whitcomb  &  Barrows. 

1902.    $1.00. 
Baruch,   Simon,  M.D.:  Principles  and  Practice  of  Hydro  therapy.    Wood. 

1908.    $4.00. 

Barrus,  Clara,  M.D.:  Nursing  the  Insane.    Macmillan.     1908.    $2.00. 
Baskerville,  Charles:  Municipal  Chemistry.    McGraw-Hill  Book  Co.    1911. 

•$5.00. 
Bastedo,  W.  A.,  M.D.:  Materia  Medica  and  Therapeutics.    Saunders.  1918. 

$4.00. 

Betts,  G.  H.:  The  Recitation.    Houghton-Mifflin.     1911.     .40. 
Beers,  Clifford  W. :  The  Mind  that  Found  Itself.    Longmans,  Green  &  Co. 

1913.    $1.50. 
Berry,  J.  Me.  W.,  M.D.:  Orthopedic  Surgery  for  Nurses.    Saunders.     1916. 

$1.00. 
Berdoe,  Edward:  Origin    and    Growth   of  the    Healing   Art.     Swan,   Som- 

merischen  &  Co.    London.     1893. 
Bigelow,   Maurice  A.   and  Anna  M. :  Applied  Biology.    Macmillan.    1911. 

$1.40. 
Bliss,  Dr.  M.  R.  and  Olive,  Prof.  A.  H.:  Chemistry  for  Nurses.    Lippincott. 

1918.    $1.59. 

157 


158  APPENDIX  I 

Blumgarten,  A.  S.,  M.D.:  Materia  Medica  for  Nurses.    Macmillan.     1916. 

$1.50. 

Boardman,  Mabel:  Under  the  Red  Cross  Flag.    Lippincott.     1918.    $1.75. 
Bolduan,  Dr.  C.  F.  and  Grund,  Marie:  Applied  Bacteriology  for  Nurses. 

Saunders.     1916.     $1.50. 
Bradford,  E.  H!,  M.D.  and  Lovett,  R.  W.,  M.D.:  Treatise  on  Orthopedic 

Surgery.     Wood.     1915.     $3.75. 

Bridge,  H.  L.:  Manual  of  Practical  Nursing.    Mosby.     1917.    $1.00. 
Broadhurst,  Jean  A.:    Home  and  Community  Hygiene.     Lippincott.     1918. 

$2.00. 
Brown,  Charlotte  A.:  The  Junior  Nurse.    Lea  &  Febriger.     (New  edition  in 

preparation.)    $1.00. 
Brunton,  T.  L.:  Lectures  on  the  Action  of  Medicines.    Macmillan.     1903. 

$4.00. 

Brubaker,  A.  P.,  M.D. :  Anatomy  and  Physiology.     Blakiston.     1916.    $3.50. 
Buchanan,  Edith  D.  and  Robert  E.:  Household  Bacteriology.    Macmillan. 

1913.     $2.40. 

Bundy,  Elizabeth:  Anatomy  and  Physiology.     Blakiston.     1916.    $2.25. 
Butler,  Alfred  M. :  Household  Physics.     Whitcomb  &  Barrows.     1914.    $1.30. 
Byington,  Margaret:  What  Social  Workers  should  know   about  their   own 

Communities.    Russell   Sage   Foundation.     (Charity  Organization    De- 
partment.    Publications.      1916.     .10. 
Cabot,  E.  L.:  Every  Day  Ethics.     Holt.     1906.     $1.36. 

Cabot,  Richard,  M.D. :  What  Men  Live  By.     Houghton-Mifflin.     1914.    $1.65. 
Cabot,  Richard,  M.D.:  Social  Service  and  the  Art  of  Healing.    Moffatt  Yard 

&  Co.     1909.    $1.35. 
Cannon,  W.  B.,  M.D.:  The  Mechanical  Factors  in  Digestion.     Longmans, 

Green  &  Co.     (New  edition  in  preparation.) 
Cannon,  W.  B.,  M.D.:  Bodily  Changes  in  Pain,  Hunger,  Fear  and  Rage. 

Appleton.     1915.    $2.50. 
Cannon,  Ida  M.:  Hospital  Social  Service.    Russell  Sage  Foundation.     1913. 

$1.50. 
Carey,  H.  W.,  M.D.:  A  Text-book  for  Nurses  in  Bacteriology.     F.  A.  Davis 

Co.     1915.    $1.00. 
Carter,  H.  S.  and  Howe,  P.  E. :  Nutrition  and  Clinical  Diet.    Lea  &  Febriger. 

1917.    $5.50. 

Campbell,  H.  C.:  Household  Economics.     Putnam.     1896.    $1.50. 
Chapin,  J.  B.:  Compendium  of  Insanity.    Saunders.     1898   (out  of  print). 
Chapin,  C.  V.,  M.D.    The  Sources  and  Modes  of  Infection.     John  Wiley. 

1916.    $3.50. 
Chapin,  R.  C.:  Standard  of  Living  Among  Workingmen's  Families  in  New 

York  City.    Russell  Sage  Foundation.     1909.    $2.00. 

Chapim,  H.  D.,  M.D.  and  Pisek,  G.  R.,  M.D.:  Diseases  of  Infants  and  Chil- 
dren.   Wood.     1915.    $3.50. 
Chapin,  H.  D.,  M.D.:  Theory  and  Practice  of  Infant  Feeding.    Wood.     (Out 

of  print.) 
Clouston,  T.  S.,  M.D.:  Hygiene  of  the  Mind.     Dutton.     1907.    $3.50. 


BIBLIOGRAPHY  159 

Colvin,  S.  S.  and  Bagley,  W.  C. :  Human  Behaviour.    Macmillan.    1913.    $1.00. 

Conn,  H.  W.:  Agricultural  Bacteriology.     Blakiston.     1918.    $2.00. 

Conn,  H.  W.:  Bacteria,  Yeasts  and  Moulds  in  the  Home.    Ginn  &  Co."    1917. 

$1.20. 
Cooke,  J.  B.,  M.D.:  A  Nurse's  Handbook  of  Obstetrics.    Lippincott.     1917. 

$2.25. 
Cooke,    Sir   Edward:  Life   of   Florence   Nightingale.    2   vols.    Macmillan. 

1914.    $7.50. 

Councilman,  W.  T.,  M.D.:  Disease  and  its  Causes.    Home  University  Li- 
brary.    1913.     .60. 

Cragin,  E.  B.,  M.D.:  Essentials  of  Gynecology.    Saunders.     1913.    $1.25. 
Crile,  G.  W.,  M.D.:  Anoci-Association.    Saunders.     1914.    $3.00. 
Crowell,  Elizabeth:  Tuberculosis  Dispensary  Method  and  Procedure.    Nat. 

Ass'n  for  the  Study  and  Prevention  of  Tuberculosis.     1916.     .25. 
Curtis,  C.  C.:  Nature  and  Development  of  Plants.    Holt.     1907.    $2.50. 
Cyriax,  E.  G.,  M.D.:  Kellgren's  Manual  Treatment.    Wood.     1904.    $4.00. 
DaCosta,  J.  C.,  M.D. :  Modern  Surgery.    General  and  Operative.     Saunders. 

1914.    $6.00. 

Davenport,  C.  B.:  Heredity  in  Relation  to  Eugenics.    Holt.    1911.    $2.50. 
Davis,   G.   G.,  M.D.:  Principles    and   Practice  of  Bandaging.    Blakiston. 

1911.    $1.00. 
Davis,  E.  P.,  M.D.:  Obstetric  and  Gynecologic  Nursing.    Saunders.    1917. 

$2.00. 
Davis,  Michael  M.,  and  Warner,  A.  R.:  Dispensaries.     Macmillan.     1918. 

•o  9c 

$-..iO. 

Dawson,  Percy,  M.D.:  Anatomy  and  Physiology  for  Nurses.    Macmillan. 

1917.    $1.75. 

De  Lee,  J.  B.,  M.D.:  Obstetrics  for  Nurses.    Saunders.     1917.    $2.75. 
Delafield,  Francis,  M.D.  andPrudden,  T.M.,  M.D. :  Pathology.    Wood.     1914. 

$7.00. 

Devine,  Edward  T.:  Misery  and  its  Causes.    Macmillan.     1913.    $1.25. 
Devine,  Edward  T. :  The  Normal  Life.    McMurtrie.    1917.    $1.15. 
Devine,  Edward  T. :  Principles  of  Relief.    Macmillan.     1904.    $2.00. 
Despard,  L.  L. :  Text-Book  of  Massage.    Hodder  &  Stoughton.     1914.    $4.00. 
Dewey,  John  and  Tufts,  J.  H. :  Ethics.    Holt.     1908.    $2.25. 
Dewey,  John:  How  We  Think.    Heath.     1910.    $1.28. 
De  Witt,  Katherine:  Private  Duty  Nursing.    Lippincott.     1917.    $1.75. 
Doane,  R.  W.:  Insects  and  Disease.    Holt.     1910.    $2.00. 
Dock,  Lavinia  L.:  Materia  Medica  for  Nurses.    Putnam.     1916.    $1.50. 
Dock,  Lavinia  L. :  Hygiene  and  Morality.     Putnam.     1912.    $1.25. 
Doty,  Alvah  H.:  Prompt  Aid  to  the  Injured.    Appleton.     1912.    $1.75. 
Dubois,  Paul:  The  Education  of  Self.    Funk  &  Wagnalls.     1914.    $1.50. 
Dubois,  Paul:  The  Influence  of  the  Mind  on  the  Body.  Funk  &  Wagnalls.  $.50. 
Dunton,  W.  R.,  M.D. :  Reconstruction  Therapy.    Saunders.     1919.    $1.50. 
Dunton,  W.  R.,  M.D.:  Occupation  Therapy.    Saunders.     1915.    $1.50. 
Eliason,  E.  L.,  M.D.:  Practical  Bandaging.    Lippincott.     1914.    $4.50. 
Eliason,  E.  L.,  M.D.:  First  Aid  in  Emergencies.     Lippincott.     1914.    $1.50. 
Ellwood,  C.  A. :  Sociology  and  Modern  Social  Problems.    American  Book  Co. 

1913.    $1.00. 


160  APPENDIX   I 

Ellis,  Havelock:  Task  of  Social  Hygiene.     Hough ton-Mifflin.    $2.75. 
Emerson,  C.  P.,  M.D.:  Essentials  of  Medicine.     Lippincott.     1918.    $2.50. 
Emerson,  Ralph  Waldo:  Essays.     Hough  ton-Mifflin.     (Cambridge  Classics). 

$1.35. 

Encyclopedia  Britannica. :  University  Press.     1914.     28vol.     $126.00. 
Epler,  Percy  H.:  Life  of  Clara  Barton.    Macmillan.     1915.    $1.75. 
Farmer,  F.  M.:  Foods  and  Cookery  for  the  Sick  and  Convalescent.    Little, 

Brown  &  Co.     1912.     $1.75. 

Farmer,  F.  M.:  Boston  Cook  Book.     Little,  Brown  &  Co.     1914.    $2.00. 
Farr,  C.  B.:  Internal  Medicine.     Lea  &  Febriger,  1913.    $2.00. 
Fisher,  Irving  and  Fiske,  E.  L.,  M.D.:  How  to  Live.     Funk  &  Wagnalls. 

1916.    $1.00. 
Foley,  Edna:  Visiting  Nurse  Manual.     Chicago  Visiting  Nurse  Association. 

1915.     .25. 
Foote,   John,   M.D.:  Essentials  of  Materia  Medica  and   Therapeutics  for 

Nurses.     Lippincott.     1918.     $1.75. 
Fowler,  R.  S.,  M.D. :  The  Operating  Room  and  the  Patient.    Saunders.     1913. 

$3.56. 
Fox,  Herbert,  M.D. :  Bacteriology  and  Protozoology.     Lea  &  Febriger.     1916. 

$1.50. 

Friedenwald  and  Rurah:  Dietetics  for  Nurses.     Saunders.     1917.     $1.50. 
Gailbraith,    Anna  M.,   M.D.:  Hygiene   and   Physical   Culture   for   Women. 

Saunders.     1917.    $2.25. 

Gardner,  Mary  S.:  Public  Health  Nursing.     Macrnillan.     1915.     SI .75. 
Gerrish.  F.  R.  M.D.:  Anatomy.     Lea  &  Febriger.     1902.     $6.50. 
Gibbs,  Winifred:  Lessons  in  Feeding  the  Family.     N.  Y.  Ass'n  for  Improving 

the  Condition  of  the  Poor.     1915.     .25. 
Gibson,  Anna:  Clinical  Laboratory  Technic.     Whitcomb  &  Barrows.     1918. 

$1.25. 
Goldmark,  Josephine:  Fatigue   and   Efficiency.     Russell   Sage   Foundation. 

1912.     $4.00. 

Gray:  Anatomy.     Lea  &  Febriger.     (20th  edition.)     1918.     $7.50. 
Graham,  Douglas,  M.D.:  Massage.     Lippincott.     1913.     $5.00. 
Grulee,  C.  L.,  M.D.:  Infant  Feeding.    Saunders.     1917.    $3.25. 
Gulick,  L.  H.  and  Ayres,  L.  P.:  Medical  Inspection  in  Schools.     Russell  Sage 

Foundation.     1913.     $1.50. 

Hall,  W.  S.,  M.D.:  Nutrition  and  Dietetics.     Appleton.     1913.     $2.25. 
Hall,  Dr.  H.  L.  and  Buck,  Mettice  C.:  The  Work  of  Our  Hands.     Moffatt, 

Yard  &  Co.     1915.     $1.50. 
Halliburton,    W.    D.,    M.D.:  Hand-book   of   Physiology.     Blakiston.     1917. 

$3.50. 

Hare,  H.  A.,  M.D.:  Practical  Therapeutics.  Lea  &  Febriger.  1918.  $4.75. 
Hcaley,  Wm.:  The  Individual  Delinquent.  Little,  Brown&  Co.  1915.  $5.00. 
Henderson,  C.  R.:  Dependents,  Defectives  and  Delinquents.  Heath.  1901. 

$2.00. 
Henry,  J.  N.,  M.D.:  A  Nurse's  Hand-book  of  Medicine.    Lippincott.     1913.. 

$2.00. 


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Hertar,  C.  A.:  Biological  Aspects  of  Human  Problems.    Macmillan.     1911. 

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Hill,  Charles,  M.D.:  Histology.    Saunders.     1914.    $2.25. 
Hill,  Charles,  M.D.:  The  New  Public  Health.    Macmillan.     1916.    $1.25. 
Hinsdale,  Guy,  M.D.:  Hydrotherapy.    Saunders.     1910.    $3.50. 
Hiss,  Dr.  P.  H.  and  Zinnser,  Dr.  Hans:  A  Text-Book  on  Bacteriology.    Ap- 

pleton.     1918.    $3.75. 

Hopkins,  W.  B.,  M.D.:  The  Roller  Bandage.    Lippincott.     1911.    $1.50. 
Hollander,  Bernard,  M.D.:  Nervous  Women.    Button.     1916.    $1.50. 
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Howell,  W.  H.,  M.D.:  Text-Book  of  Physiology.    Saunders.     1918.    $5.00. 
Hughes,  D.  E.,  M.D.:  Practice  of  Medicine.    Blakiston.     1917.    $3.25. 
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Jackson,  G.  T.,  M.D.:  Diseases  of  the  Skin.    Lea  &  Febriger.     1914.    $3.00. 
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James,  William:  Psychology  (Briefer  Course).    Holt.     1892.    $1.75. 
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Kelley,  Florence:  Modern  Industry.    Longmans,  Green  &  Co.  (temporarily 

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Kelly,  H.  A.,  M.D. :  Medical  Gynecology.    Appleton.     1912.    $6.50. 
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Kerley,  C.  G.,  M.D.:  Practice  of  Pediatrics.    Saunders.     1918.    $6.50. 
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Kinne  and  Cooley:  Shelter  and  Clothing.    Macmillan.     1913.    $1.10. 
Kingsbury,  Susan:  Vocations  for  the  Trained  Woman.     Longmans,  Green  & 

Co.     1910.    $1.50. 

Kinnicutt,  Winslow  and  Pratt:  Sew  age  Disposal.     Wiley  &  Son.     1916.    $3.00. 
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Kittredge,  Mabel  H. :  Practical  Home  Making.    Century  Co.     1917.     .60. 
Knopf,  S.  A.:  Tuberculosis  as  a  Curable  and  Preventable  Disease.    Moffatt, 

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Kober,  G.  M.:    Industrial  and  Personal  Hygiene.    President's  Homes  Com- 
mission.   Washington.     1908. 

Kraeplin,  Emil,  M.D.:  Clinical  Psychiatry.    Vol.  111.    Wood.  1917.    $3.50. 
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Langworthy:  Food  Customs  and  Diet  in  American  Homes.     U.  S.  Dept.  of 

Agriculture.     Bulletin  110. 

La  Motte,  Ellen  N.:  Tuberculosis  Nursing.     Putnam.     1915.    $1.50. 
Latimer,  Caroline  W.,  M.D.:  Girl  and  Woman.    Appleton.     1909.    $1.75. 
Lee,  F.  S.,  M.D.:  Scientific  Features  of  Modern  Medicine.     Lemcke.     1911. 

$1.50. 

Lee,  Roger  I.:  Health  and  Disease.     Little,  Brown  &  Co.     1917.    $2.00. 
Lee,  Joseph:  Play  in  Education.     Macmillan.     1915.    $1.50. 
Loch,  C.  S.:  Charity  and  Social  Life.    Macmillan.     1910.     $2.00. 
Lounsbury,  H.  C.:  Making  Good  on  Private  Duty.     Appleton.     1912.     $1.25. 
Lovett,  R.  \V.,  M.D.:  Lateral  Curvature  of  the  Spine  and  Round  Shoulders. 

Blakiston.     1916.     $1.75. 

Lynch,  Lt.  Col.  Charles:  Red  Cross  Text-Book  on  First  Aid  and  Relief  Col- 
umns.   Blakiston.     1918.     $1.00. 

Lynde,  C.  J. :  Household  Physics.     Macmillan.     1904.     SI. 25. 
MacFarlane,    Catherine,    M.D.:  Gynecology   for   Nurses.     Saunders.     1913. 

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Mackenzie,  W.  L.:  Health  and  Disease.     Home  University  Library.     1911. 

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Mackenzie.  J.  S. :  Manual  of  Ethics.     Hinds,  Noble  &  Eldridge.     1901.    S1.50. 
Mackenzie,    James:  Symptoms    and    their    Interpretation.     Chicago    Med. 

Book  Co.     1909.     $3.00. 
MacPherson,  Wm.  and  Henderson,  W.  E.:  Elementary  Study  of  Chemistry. 

Ginn  &  Co.     1917.     $1.60. 

Marshall,  A.  M.:  Vertebrate  Embryology.     Putnam.     1893.    $6.00. 
Marshall,   C.   E.:  Microbiology.     Blakiston.     1917.     $3.00. 
Martin,  H.  N.:  Human  Body.     Holt.     1917.     S3.00. 
Maxwell,  Anna  C.  and  Pope,  Amy  E.:  Practical  Nursing.     Putnam.     1914. 

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May,  C.  H.,  M.D.:  Diseases  of  the  Eye.     Wood.     1917.    $2.50. 
McCollurn,  E.  V. :  The  Newer  Knowledge  of  Nutrition.    Macmillan.     1918. 

$1.50. 
McCombs,  R.  S.,  M.D.:  Diseases  of  Children  for  Nurses.     Saunders.     1916. 

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McCunn,  John:  Making  of  Character.     Macmillan.     1910.     $1.25. 
McDougall,  Wm.  Social  Psychology.     Luce  &  Co.     1909.     $1.50. 
McTsaac,  Isabel:  Primary  Nursing  Technique.     Macmillan.     1907.     $1.25. 
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McNutt.  J.  S. :  Manual  for  Health  Officers.    Wiley  &  Sons.    1915.    $3.00. 
McMurry,  F.  M.:  How  to  Study.     Houghton-Mifflin.     1909.    $1.50. 
Meachen,  G.  Norman:  Diseases  of  the  Skin  for  Nurses.     (English  Importa- 
tion).    Chicago  Mcd.  Book  Co.     $1.25. 

Miller,  Irving,  E.:  Psychology  of  Thinking.     Macmillan.     1909.     $1.25. 
Mitchell,  J.  L.,  M.D.,  and  Guliok,  Luther,   M.D.:    Mechano  Therapy  and 

Physical  Education.     Blakiston.     $300. 
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1911      $2.50. 


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Morse,  J.  L.,  M.D.:  Care  and  Feeding  of  Children.    Harvard  University 
Press.    1914.    $.50. 

Morse,  J.  L.,  M.D.,  and  Talbot,  F.  B.,  M.D. :  Diseases  of  Nutrition  and  Infant 
Feeding.    Macmillan.    1915.    $3.00. 

Morrow,  A.  S.,  M.D.:  Immediate  Care  of  the  Injured.    Saunders.    1917. 
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Morrow,  Prince  A.,  M.D.:  Social  Diseases  and  Marriage.    Lea  Bros.     1904. 
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Mozans,  H.  J.:  Women  in  Science.    Appleton.    1915.    $2.50. 

Mullerheim:  Die  Wochenstube  in  der  Kunst.    F.  Enke,  Stuttgart.    1904. 

Munsterberg,  Hugo :  Psychotherapy .    Moffatt,  Yard  &  Co.    1909.    $2.25. 

Nearing,    Scott:  Financing   the   Wage    Earner's    Family.    Huebsch.    1914. 
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Nesbitt,  Florence :  Low  Cost  Cooking.    American  School  of  Home  Economics, 
Chicago.    1915.    $.50. 

Newsholme,  A.,  M.D.:  The  Prevention    of    Tuberculosis.    Dutton.     1916. 
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Nightingale,  Florence :  Notes  on  Nursing.    Appleton.    1917.    (Last  printing). 
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Nightingale,  Florence:  Talks  to  Pupils.    A  selection  of  addresses  to  proba- 
tioners and  nurses.    Macmillan.    London.     1914. 

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Nutting,  M.  Adelaide,  and  Dock,  Lavinia  L.:  History  of  Nursing.    4  vols. 
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Oliver,  Thomas,  M.D.:  Diseases  of  Occupation.    Dutton.     1917.    $4.00. 

Osier,  William,  M.D. :  Practice  of  Medicine.    Appleton.    1916.    $6.00. 

Osier,   William,   M.D.:   An  Alabama  Student  and  Other  Essays.     Oxford 
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Paget,  Stephen:  Confessio  Medici.    Macmillan.    1908.    $1.25. 

Palmer,  Margaret  D.:  Lessons  on  Massage.    Wood.     1908.    $3.50. 

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Parker,  Linette  A.:  Materia  Medica.    Lea  &  Febriger.     1916.    $1.75. 

Parker,  E.  M.,  M.D.,  and  Breckinridge,  S.  D.,  M.D.:  Surgical  and  Gynecolog- 
ical Nursing.    Lippincott.     1916.    $2.50. 

Parker,   W.   H.,   M.D.,    and    Williams,    Anna,    M.D.:    Pathogenic    Micro- 
organisms.   Lea  &  Febriger.     1918.    $4.75. 

Parker,  T.  J.,  and  Haswell,  W.  A.:  Text-book  of  Zoology.    2  vols.    Macmillan. 
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Parloa,  Maria:  Home  Economics.    Century  Co.     1906.    $1.50. 

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Paul,  G.  P.,  M.D.:  Nursing  in  the  Acute  Infectious  Fevers.    Saunders.     1915. 

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Piersol,  G.  A.,  M.D.:  Normal  Histology.    Lippincott.     1916.     $3.50. 
Pillsbury,  W.  B.:  Essentials  of  Psychology.    Macmillan.     1911.    $1.25. 
Polak,  J.  O.,  M.D. :  Manual  of  Obstetrics.    Appleton.     1913.    $3.00. 
Pope,  Amy  E. :  Anatomy  and  Physiology  for  Nurses.     Putnam.     1917.    $2.00. 
Pope.  Amy  E.:  Physics  and  Chemistry  for  Nurses.    Putnam.     1918.    $2.00. 
Pope,  A.  E.,  and  Carpenter,  M.  T. :  Essential  of  Dietetics.    Putnam.     1917. 

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Potts,  C.  S.,  M.D.:  Electricity  in  Medicine  and  Surgery.    Lea  &  Febriger. 

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Price,  G.  M.:  Hygiene  and  Sanitation  for  Nurses.    Lea  &  Febriger.    1917. 

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Priestman,  Mabel  T.:  Art  and  Economy  in  Home  Decoration.    John  Lane  & 

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Putnam,  Mrs.  Geo.  Haven:  The  Lady.    Sturgis  &  Walton.    $1.25. 
Pyle,  W.  L.,  M.D. :  Personal  Hygiene.    Saunders.     1918.    $1.75. 
Ramsey,  W.  R.,  M.D.:  Care  and  Feeding  of  Infants  and  Children.    Lippin- 
cott.   1916.    $2.00. 

Register,  W.  R.,  M.D  :  Practical  Fever  Nursing.    Saunders.     1907.    $2.50. 
Ribot,  T.  A. :  Diseases  of  the  Personality.     Boericke  &  Tafel.     1909.    $1.00. 
Ribot,  T.  A. :  Diseases  of  the  Will.    Open  Court  Pub.  Co.     1903.    $.75. 
Richards,  Ellen  H.:  Home  Sanitation  in  Daily  Life.    Whitcomb  &  Barrows. 

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Richards,  Ellen  H.:  Euthenics.    Whitcomb  &  Barrows.     1910.    $1.00. 
Richmond,  Mary:  Social  Diagnosis.    Russell  Sage  Foundation      1916.    $1.75. 
Richer:  L'Art  et  la  Medicene.    Gaultier,  Magnier  et  Cie.    Paris.     1902. 
Robb,  Isabel  Hampton:  Nursing  Principles  and  Practice.    Koeckert.     1917. 

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Robb,  Isabel  Hampton:  Ethics  of  Nursing.    Koeckert.     1917.    $1.50. 
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Robb,  Hunter,  M.D. :  Aseptic  Surgical  Technic.    Lippincott.     1916.    $2.50. 
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Rose,  W.  R.,  and  Carless,  Albert:  Manual  of  Surgery.    Wood.     1917.    $7.00. 
Rose,  Mary  S.:  Feeding  the  Family.    Macmillan.     1916.    $2.10. 
Rose,  Mary  S. :  Food  for  School  Boys  and  Girls.     (Bulletin)  Teachers  College. 

Columbia  Univ.  Series  No.  10. 
Rose,  Mary  S. :  Cost  of  Food.    Cornell  Bulletin.     Food  Series  No.  7. 


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Rose,    Mary    S.    Handbook    of    Laboratory    Dietetics.    Macmillan.    1912. 

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Ross,  Edward  A. :  Social  Psychology.    Macmillan.     1908.    $1.50. 
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Sainsbury,  Harrington:  Drugs  and  the  Drug  Habit.    Dutton.    1909.    $3.50. 
Sanders,  Georgina  J. :  Modern  Methods  in  Nursing.     1916.    $2.50. 
Saleeby,  C.  W.:  Surgery  and  Society.    Moffatt,  Yard  &  Co.    1912.    $2.50. 
Schreiner,  Olive:  Woman  and  Labor.    Stokes.    1911.    $1.25. 
Seager,  Henry:  Social  Insurance.    Macmillan.     1910.    $1.00. 
Sedgwick,  W.  T. :  Principles  of  Sanitary  Science  and  Public  Health.    Macmil- 
lan.    1902.    $3.00. 
Senn,  Nicholas,  M.D.:  Operating-Room  Technic.    Chicago  Med.  Book  Co. 

1905.    $1.75. 
Sherman,   H.   C.:  Chemistry   of    Food   and   Nutrition.    Macmillan.    1918. 

$2.00. 
Snedden,    F.   H.:  Problem   of   Vocational   Education.    Houghton,    Mifflin. 

1910.    $.40. 

Slemons,  J.  M.,  M.D.:  Prospective  Mother.     Appleton.     1912.    $1.75. 
Smith,  Richard  M.  and  Mrs.  H.  Greene :  Baby's  First  Two  Years.    Houghton- 

Mifflin.     1915.    $.85. 

Smith,  Amy  Armour:  The  Operating  Room.    Saunders.     1916.    $1.50. 
Sollmann,    Torald.    M.D.:  Text-book    of    Pharmacology.    Saunders.     1917. 

$1.50. 
Starling,  E.  A.:  Principles  of  Human  Physiology.    Lea  &  Febriger.    1915. 

$6.00. 

Starr,  Louis,  M.D.:  Hygiene  of  the  Nursery.    Blakiston.    1913.    $1.00. 
Stevens,  A.  A. :  Practice  of  Medicine.    Saunders.     1915.    $3.00. 
Stevens,  A.  A.,  M.D.:  Materia  Medica  and  Therapeutics.    Saunders.    1909. 

$3.50. 

Steiner,  E.  A.:  Ebb  and  Flow  of  the  Immigrant  Tide.    Revell.    1909.    $1.50. 
Steiner,  G.  A.:  On  the  Trail  of  the  Immigrant.    Revell.     1909.    $1.50. 
Stelwagon,  H.  W.,  M.D.:  Diseases  of  the  Skin.    Saunders.     1916.    $6.50. 
Stiles,  P.  G.:  Nutritional  Physiology.    Saunders.     1918.    $1.50. 
Stimson,  Julia:  Nurses  Handbook  of  Drugs  and  Solutions.    Whitcomb  &  Bar- 
rows.    1915.    $1.00. 
Strayer,   Geo.   G.,   and  Norsworthy,   Naomi:  How   to  Teach.    Macmillan. 

1917.    $1.40. 

Streightoff,  F.  H.:  Standard  of  Living.    Houghton-Mifflin.     1911.    $1.25. 
Struthers,  Lina  Rogers:  School  Nursing.     Putnam.     1917.    $1.75. 
Taylor,  F.  W.:  Shop  Management.    Harper  Bros.     1911.    $1.50. 
Terrill,  Bertha  M. :  Household  Management.    Am.  School  of  Home  Economics. 

1910.    $1.00. 
Tiffany,   Rev.   Francis:   Life  of  Dorothea  Lynde   Dix.     Houghton-Mifflin. 

1890.    $1.75. 

Tigerstedt,  R.  A.,  M.D.:  Text  Book  of  Physiology.    Appleton.     1916.    $4.50. 
Thompson,  W.  Oilman,  M.D.:  Practical  Dietetics.    Appleton.     1909.    $5.50. 


166  APPENDIX   I 

Thompson,  W.  Oilman,  M.D.:  Occupational  Diseases.  Appleton.  1914. 
$6.50. 

Thorndike,  E.  L.:  Individuality.    Houghton-Miffiin.     1917.    $.40. 

Thorndike,  E.  L. :  Principles  of  Teaching,  Based  on  Psychology.  Seller. 
1906.  $1.25. 

Thorndike,  E.  L.    Elements  of  Psychology.    Seiler.    1907.    $1.50. 

Thorndike:  Orthopedic  Surgery.    Blakiston.     (Out  of  print.) 

Tooley,  Sarah:  History  of  Nursing  in  the  British  Empire.    Cassell.    London. 

Tracy,  Susan  E. :  Invalid  Occupations.    Whitcomb  &  Barrows.     1910.    $1.50. 

Tracy,  Susan  E. :  Rake  Knitting.    Whitcomb  &  Barrows.     1916.    $  .25. 

Tubby,  A.  H.:  Deformities.  2  vols.  Macmillan.  1912.  (Imported  to  order 
only.)  $16.00. 

Tuker  and  Malleson:  Handbook  to  Christian  and  Ecclesiastical  Rome.  Mac- 
millan. 1897.  $2.75. 

Tyler,  J.  M.:  Growth  and  Education.    Houghton-Miffiin.     1907.    $1.50. 

Vulte,  H.  T.:  Household  Chemistry.    Chemical  Publishing  Co.     1917.    $1.50. 

Veiller,  Lawrence:  Housing  Reforms.  Russell  Sage  Foundation.  1910. 
$2.00. 

Waters,  Yssabella:  Visiting  Nursing  in  the  United  States.  Russell  Sage 
Foundation.  1912.  $1.25. 

Wells,  H.  G. :  Chemical  Pathology.    Saunders.     1918.    $4.25. 

West,  (Mrs.  Max) :  Care  of  Children.  (Pamphlet)  Children's  Bureau.  Wash- 
ington, D.  C. 

West,  (Mrs.  Max) :  Prenatal  Care.  (Pamphlet)  Children's  Bureau.  Washing- 
ton. 

Wharton,  H.  R.:  Minor  Surgery  and  Bandaging.  Lea  and  Febiger.  1913. 
$2.00. 

Wheeler,  Mary  C. :  Nursing  Technique.    Lippincott.     1918.    $1.50. 

Whipple,  G.  M.:  How  to  Study  Effectually.  Public  School  Pub. Co.  1916. 
$.50. 

White,  W.  A.,  M.D.:  Outlines  of  Psychiatry.  Nervous  and  Mental  Disease 
Pub.  Co.  Washington,  D.  C.  $3.00. 

White,  W.  A.,  M.D.:  Principles  of  Mental  Hygiene.  Macmillan.  1917. 
$2.00. 

Wiedersheim:  Comparative  Anatomy.    Macmillan.     (Out  of  print.) 

Williams,  J.  W.,  M.D.:  Obstetrics.    Appleton.     1917.    $2.00. 

Wilcox,  R.  W.,  M.D. :  A  Manual  of  Fever  Nursing.    Blakiston.    1908.    $1.00. 

Wilson,  J.  C.,  M.D.:  Fever  Nursing.    Lippincott.     1915.    $1.50. 

Withington,  Edward  T.:  Medical  History  from  the  Earliest  Times.  London. 
1894. 

Wood,  F.  C.,  M.D. :  Chemical  and  Microscopical  Diagnosis.  Appleton.  1917. 
$5.50. 

Zinnser,  Hans:  Infection  and  Resistance.    Macmillan.     1918.    $4.25. 

Zangwill,  Israel:  The  Melting  Pot.    Macmillan.    1914.    $1.50. 


APPENDIX  II 

Inexpensive  and  Free  Bulletins,  Pamphlets  and  Reports  for  use  in  teach- 
ing nurses,  may  be  secured  by  writing  to  the  following  organizations,  bureaus 
and  firms.  By  explaining  the  purpose  for  which  it  is  to  be  used,  much  of  this 
literature  can  be  secured  in  quantities  for  distribution. 

American  Association  for  Conservation  of  Life,  1  Madison  Avenue,  New 

York  City. 
American  Association  for  Labor  Legislation,  131  E.  23d  Street,  New  York 

City. 
American  Association  of  Societies  for  Organizing  Charity,  105  East  22d  Street, 

New  York  City. 
American  Association  for  Study  and  Prevention  of  Infant  Mortality,  1211 

Cathedral  Street,  Baltimore,  Md. 

American  Home  Economics  Association,  Roland  Park,  Baltimore,  Md. 
American  Posture  League,  1  Madison  Avenue,  New  York  City. 
American  Public  Health  Association,   126  Massachusetts  Avenue,   Boston, 

Mass. 

American  Red  Cross,  Washington,  D.  C. 

American  Social  Hygiene  Association,  105  West  40th  Street,  New  York  City. 
American  Society  for  Control  of  Cancer,  25  West  45th  Street,  New  York  City. 
American  Medical  Association,  525  North  Dearborn  Street,  Chicago,  111. 
Association  for  Improving  the  Condition  of  the  Poor,  105  East  22d  Street, 

New  York  City. 

Association  of  Tuberculosis  Clinics,  105  East  22d  Street,  New  York  City. 
Cornell  University,  Ithaca,  N.  Y.     (Bulletins  for  Farmers'  Wives.) 
Children's  Bureau,  Department  of  Labor,  Washingon,  D.  C.     (Pamphlets 

on  Prenatal  and  Child  Care,  etc.) 
Departments  of  Health — State  and  City.     (Weekly,  Monthly  and  Special 

Bulletins  and  Reports.) 

Fairchild  Foster  and  Bro.,  New  York  City.     (Diet  Slips.) 
General  Electric  Company,  Cleveland,  Ohio.     (Pamphlet  on  First  Aid.) 
Health  Education  League,   18  Beacon  Street,  Boston,  Mass.     (24  popular 

pamphlets  on  Hygiene  and  Sanitation.) 

Housekeeping  Experiment  Station,  28  Hoyt  Street,  Stamford,  Conn.     (Pam- 
phlets on  Efficiency  and  Household  Management.) 
International  Child  Welfare  League,  70  Fifth  Avenue,  New  York  City. 
Joint  Committee  on  Prison  Reform,  105  West  40th  Street,  New  York  City. 
Life  Extension  Institute,  25  West  45th  Street,  New  York  City. 
Massachusetts  Society  for  Mental  Hygiene,   15  Ashburton  Place,  Boston, 

Mass. 
Metropolitan  Life  Insurance  Co.,  New  York  City.     (Pamphlets  on  Hygiene, 

first  aid,  etc.) 
National  Association  for  Study  and  Prevention  of  Tuberculosis,  105  East 

22d  Street,  New  York  City. 

167 


168  APPENDIX   II 

National  Child  Labor  Committee,  105  East  22d  Street,  New  York  City. 

National  Child  Welfare  Exhibit  Association,  70  Fifth  Avenue,  New  York  City. 

National  Civic  Federation,  1  Madison  Avenue,  New  York  City. 

National  Committee  on  Mental  Hygiene,  50  Union  Square,  New  York  City. 

National  Committee  for  Prevention  of  Blindness,  130  East  22d  Street,  New 
York  City.  (Pamphlets  and  posters.) 

National  Conference  of  Charities  and  Corrections,  315  Plymouth  Court, 
Chicago,  111. 

National  Consumers'  League,  105  East  22d  Street,  New  York  City. 

National  Organization  of  Public  Health  Nursing,  156  Fifth  Avenue,  New 
York  City. 

National  Housewives'  League,  25  West  45th  Street,  New  York  City. 

New  York  Committee  on  the  Prevention  of  Blindness,  105  East  22d  Street, 
New  York  City. 

New  York  School  of  Philanthropy,  105  East  22d  Street,  New  York  City. 
(Pamphlets  on  Social  Work.) 

Russell  Sage  Foundation,  130  East  22d  Street,  New  York  City.  (Bulletins 
on  Education  and  Social  Welfare.) 

Rockefeller  Foundation,  66th  Street  and  Avenue  A.,  New  York  City.  (Bulle- 
tins on  Medical  Research.) 

Teachers  College,  Columbia  University,  New  York  City,  (Technical  Edu- 
cation Bulletins  on  Nutrition,  Diet,  Clothing,  Etc.,  including  "Anno- 
tated list  of  text  and  reference  books  for  Training  Schools  for  Nurses," 
and  "Opportunities  in  the  Field  of  Nursing.") 

U.  S.  Bureau  of  Education,  Washington,  D.  C.  (Bulletins  on  Education, 
Medical  Inspection,  Rural  Problems,  etc.,  including  "Educational  Status 
of  Nursing.") 

U.  S.  Department  of  Agriculture,  Washington,  D.  C.  (Bulletins  on  Foods, 
Food  Adulteration,  Food  Preparation,  Household  Pests,  Disinfectants, 
etc.) 

U.  S.  Department  of  Labor,  Washington,  D.  C.  (Bulletins  on  Industrial 
Conditions,  Safety,  Industrial  Poisons,  Fatigue,  etc.) 

U.  S.  Public  Health  Service,  Washington,  D.  C.  (Bulletins  on  Sanitation, 
Preventive  Medicine,  Infectious  Diseases,  etc.) 

See  also  list  of  firms  supplying  equipment  and  illustrative  material. 


APPENDIX  III 

Some  Firms  Supplying  Equipment  and  Illustrative  Material  of  Use  in 
Schools  of  Nursing.  Sample  exhibits  from  commercial  firms  can  sometimes 
be  secured  free  if  it  is  understood  that  they  are  to  be  used  for  educational 
purposes. 

American  Red  Cross,  First  Aid  Dept.,  Washington,  D.  C.     (Charts  and  First 

Aid  Outfits.) 
American  Social  Hygiene  Association.     105  W.  40th  Street,  New  York  City. 

(Series  of  colored  posters  on  social  hygiene.    May  be  sent  as  loan  exhibit 

on  request.) 

American  Posture  League.     1  Madison  Avenue,  New  York.     (Charts  on  Pos- 
ture.) 

Arnold,  E.  J.  and  Son,  Leeds,  England.     (Food  Charts.) 
Baker  and  Company,   159  Franklin  Street,   New  York.     (Sample  exhibit, 

cocoa  and  chocolate,  crude  materials  and  preparations.) 
Bausch  and  Lomb.    Rochester,  N.  Y.     (Microscopes,  Lanterns,  etc.) 
Berlin  Photographic  Company.     New  York.     (Prints  and  Photographs.) 
Betz,  Frank  S.  and  Company.    Hammond,  Ind.     (Hospital  and  Laboratory 

Supplies.) 

Bridgman,  E.G.    86  Warren  Street,  New  York.     (Beef  Chart.) 
Burnett,  Joseph  and  Company.    Boston,  Mass.     (Samples  of  vanilla  bean 

and  pamphlet.) 

Caxton  School  Supply  Company,  Chicago,  111.     (Blackboards,  Erasers,  etc.) 
Chase,  M.  J.    Pawtucket,  R.  I.     (Hospital  Doll  or  Model.) 
Colgate  and  Company.    New  York.     (Samples  of  Soaps,  Talcum  Powders, 

etc.,  with  Pamphlets.) 

Cosmos  Picture  Company.    New  York.     (Inexpensive  Prints.) 
Curtis  and  Cameron.     Boston,  Mass.     (Copley  Prints.) 
Educational  Equipment  Company,  70  Fifth  Avenue,  New  York  City.     (School 

and  College  Outfitters.) 
Educational  Exhibition  Company.    Providence,  R.  I.     (Material  for  graphic 

presentation  of  facts.) 

Eimer  and  Amend.    205  3d  Avenue,  New  York.     (Laboratory  Equipment.) 
First  Aid  Equipment  Company.    New  York.     (First  Aid  Outfits.) 
Coder,  Heinman  Company.     Chicago,  111.     (Charts  and  Models.) 
Hammond  Attilliers.     Chicago,  111.     (Specimens,  Skeletons,  Models,  etc.) 
Harvard  Apparatus  Company.     Cambridge,   Mass.     (Scientific  Laboratory 

Supplies.) 
Hecker  Milling  Company.    New  York.     (Educational  Exhibit  of  Flour  and 

Cereals.) 

Huyler's.    64  Irving  Place,  New  York.     (Educational  Exhibit  Cocoa,  Choco- 
late, etc.,  and  Charts.) 
Johnson  and  Johnson.     New  Brunswick,  N.  J.     (Surgical  Materials,  First 

Aid  Cabinets  with  booklets  on  First  Aid.) 

169 


170  APPENDIX   III 

Knott  Apparatus  Company.  Boston,  Mass.  (Bacteriological  and  Patho- 
logical Supplies.) 

Kny  Scheerer  Company.  New  York.  (Hospital  Supplies,  Models,  Skele- 
tons, Microscopes,  Slides,  and  Laboratory  Equipment.) 

Lippincott  Company.    Philadelphia,  Pa.     (Piersol  Anatomical  Charts.) 

Louis  Company,  O.  T.,  59th  Street  and  5th  Avenue,  New  York.  (Mannikins, 
Laboratory  Equipment,  etc.) 

Lowney's.    Boston,  Mass.     (Educational  Exhibit,  Chocolate,  Cocoa,  etc.) 

Mclntosh  Stereoptican  Company.    Chicago,  111.     (Lantern  Slides.) 

Museum  of  Natural  History.     New  York.     (Slides,  Cultures,  etc.) 

National  Child  Welfare  Exhibit  Association.  70  Fifth  Avenue,  New  York 
City.  (Series  of  25  colored  Posters  on  Baby  Welfare.) 

Nystrom  and  Company.  623  South  Wabash  Avenue.  Chicago,  111.  (Charts, 
Skeletons,  Models,  etc.  Agents  for  W.  and  A.  K.  Johnston's  and  the 
Frohse  Charts.) 

Parke,  Davis  and  Company.  Detroit,  Mich.  (Drugs,  Cabinets  of  Crude 
Drugs,  etc.) 

Postum  Cereal  Company.  Battle  Creek,  Mich.  (Postum,  Cereal  Exhibit — 
Free.) 

Proctor  Gamble  Company.  Cincinnati,  Ohio.  (Laundry  Materials.  Sam- 
ples of  Soaps,  Starches,  etc.,  and  pamphlet  on  Laundering.) 

Royal  Baking  Powder  Company.  135  William  Street,  New  York.  (Sam- 
ples showing  composition  of  Baking  Powder,  Free.) 

Scientific  Instrument  Company.     Chicago,  111.     (Laboratory  Supplies.) 

Sheldon,  E.  H.,  and  Company.  Muskegon,  Mich.  (Laboratory  Tables  for 
Cooking,  Physics,  Biology,  Chemistry,  etc.) 

Spencer  Lens  Company.    Buffalo,  N.  Y.     (Microscopes,  Delineascopes.) 

Stickney  and  Poor  Spice  Company.    Boston,  Mass.     (Sample  Case  of  Spices.) 

U.  S.  Depart,  of  Agriculture.  Washington,  D.  C.  (Charts  on  Metric  System, 
Food  Composition  and  Values  and  Measuring  Systems.) 

U.  S.  Public  Health  Service.  Washington,  D.  C.  (Stereopticon  Loan  Li- 
brary on  Public  Health  Subjects.) 

Ward  Natural  Science  Establishment.  Rochester,  N.  Y.  (Skeletons,  Cul- 
tures, Slides,  etc.) 

Washburn  and  Crosby.  Minneapolis,  Minn.  (Samples  of  Food  Stuffs. 
Free.) 

Whitcomb  and  Barrows.  Huntington  Chambers,  Boston,  Mass.  (Food 
Charts.) 

Women's  Home  Companion.  381  Fourth  Avenue,  New  York.  (Baby  Charts 
and  Bulletins  from  Better  Babies  Bureau.) 

Worcester  Salt  Company.    New  York.     (Salt  Samples  and  booklet.) 


APPENDIX  IV 

Physical  Exercises 

A  few  suggestions  for  simple  exercises  which  are  designed  especially  to 
meet  the  needs  of  nurses.    May  be  given  early  in  the  course  in  connection 
with  classes  in  Hygiene  or  independently. 
General  Exercise 

1.  Take  good  standing  position.    Hands  to  shoulders,  elbows 
bent.    Extend  arms  slowly  sideways  and  bend  knees.    Bring 
arms  to  shoulders  and  straighten  knees. 

2.  Standing   erect.     Hands    on    hips.     Draw    head    slowly 
backward  horizontally,  keeping  chin  drawn  in. 

3.  Standing  erect.    Place  hands  on  top  of  head.    Stretch 
body  upward  as  far  as  possible  keeping  heels  on  the  floor; 
extend  arms  upward,  then  press  arms  slowly  sideways  down- 
ward to  side  of  the  body  (hands  facing  floor) . 

4.  Standing  erect.    Hands  on  hips.     Bend  trunk  forward 
from  hips,  keeping  the  back  flat.    Do  not  curve  the  back. 

5.  Standing  erect.    Arms  extended  sideways.     Bend  trunk 
to  each  side. 

(Exercise  to  be  done  from  8-10  times  each.) 
Exercises  for  Posture  and  Walking 

1.  Practice  standing  erect,  as  tall  as  possible  without  strain 
and  without  hollowing  the  back.    Abdomen  drawn  in,  waist 
muscles  firm;  head  easily  poised,  and  arms  hanging  freely  at 
sides.    Relax  body  then  take  position  time  after  time,  till 
habit  of  correct  posture  is  established. 

2.  Take  posture  as  in  1.    Raise  arms  slowly  sideways  to 
horizontal  and  raise  heels.     Chest  high. 

3.  Position  as  in  1.    Hands  on  hips.    Place  one  foot  forward — 
sway  weight  of  body  to  forward  foot,  by  lifting  the  backward 
heel. 

4.  Position  as  in  1.    Hands  on  hips.    Sway  body  backward, 
forward,  and  to  each  side,  keeping  good  posture. 

5.  In  walking  let  weight  fall  on  the  ball  of  the  foot,  turn 
toes  straight  ahead,  and  preserve  spring. 

Breathing  Exercises 

1.  Standing.    Arm  raising  sideways  with  deep  inspiration. 
Return  to  first  position  with  expiration  (8-10  times.) 

2.  Standing.    Raise  arms  slowly  forward  upward,  allowing 
hands  to  droop,  keeping  them  close  to  the  body,  till  extended 
above  the  head.    Deep  inspiration.    Return  to  first  position 
sinking  slowly  sideways.    Expiration.     (5-8  times.) 

3.  Standing.    Arms    extended    sideways.    Rotate    arms    in 
large  circles  and  breathe  deeply.     (8-10  times.) 

171 


172  APPENDIX   IV 

4.  Lie  on  the  back' — hands  behind  the  neck — knees  slightly 
bent— feet  on  floor.     Practice  taking  long,   deep  breaths  to 
establish  a  longer  deeper  rhythm. 
Exercises  for  Arms 

Sitting  Erect. 

1.  Arms    extended    upward,     hands    clenched.     Draw  arms 
slowly  and  forcibly  downward,  as  though  pulling  heavy  weight. 
Extend  upward  without  force. 

2.  Hands  at  shoulders.     Push  forcibly  upward,   as  though 
lifting  heavy  weight,  and  return  to  first  position  without  force. 

3.  Hands  at  shoulders.     Extend  arms  slowly  and  forcibly 
sideways. 

(Each  exercise  5-10  times.) 
Exercises  for  Legs  and  Feet 

Position— standing  erect. 

1.  Hands  on  hips.     Heel  raising. 

2.  Hands  on  hips.     Alternate  heel  raising  and  toe  raising. 

3.  Hands  on  hips.     Bend  knee  upward  to  right  angles  with 
the  body.     Stand  firmly  on  opposite  foot. 

(Each  exercise  10-15  times.) 

Position  with  feet  parallel  or  slightly  turned  in. 

1.  Raise  on  toes;  bring  heels  to  floor  again  rolling  slightly 
on  outer  borders  of  feet.     (10-20  times.) 

2.  Roll  feet  on  outer  borders.     (15-20  times.) 

3.  Walk  on  outer  borders  of  feet  with  toes  turned  in. 

4.  Sitting.     Raise    arches    by    drawing    toes  toward    heels, 
keeping  both  toes  and  heels  on  floor.     (Valuable  because  it 
may  be  done  indefinitely  with  shoes  on. 

Exercises  for  Constipation 

1.  Lie  on  back — knees  bent— feet  on  floor.     Draw  knees  to 
chest,    making    pressure    on    abdomen.    Very    slowly.     (8-10 
times.) 

2.  Lie  on  back' — legs  extended.    Draw  knees  upward  rolling 
toward  right  swing  knees  in  circle  across  to  left  side,  keeping  the 
upper  part  of  the  body  from  turning,  then  extend  legs  slowly 
to  first  position.     (5  times.) 

3.  Sitting — hands    on    hips.     Bend    body    forward.     Relax, 
then  circl'j  to  each  side.     (8-10  times  each  side.) 


APPENDIX  V 


Scheme  Number  1 
Credit  of  9  months.    Period  of  training  covers  2  years  and  3  months  (#7  months) 

Service  or  Department.  Month. 

Preparatory 4 

Medical 5 

Surgical 5 

Children '3 

Maternity 3 

Operating  room. 

Accident  ward  ,    .        ,  0          , ,     .               .                       ,  ,, 

^.                      ,  a  choice  of  3  months  is  given  m  any  one  of  these        _ 

Dispensary  and  .                                                                                  }  3 

,,     f ,  „       .  services 

Social  Service  or 

Visiting  Nursing 

Night  duty 2 

Vacation 2 

27 
Scheme  Number  2 

Credit  of  9  months.    Period  of  training  covers  ffl  months 

Preparatory 4 

Medical 4 

Surgical 4 

Children 4 

Maternity 2 

Contagious 3 

Mental 3 

Night  Duty  (to  be  included  in  above  services) 

Opeiating  room If 

Vacation If 

Dispensary  (students  to  be  sent  to  dispensary  in  last  months  of  various 
services) 

27 
Scheme  Number  8 

Credit  of  8  months.    Period  of  training  covers  28  months 

Preparatory  (including  Diet  School  and  surgical  supply  room) 4 

Medical  (including  contagious  services  and  1  month's  night  duty) 6 

173 


174  APPENDIX    V 

Surgical  (including  operating  room  or  accident  ward,  or  surgical  dispen- 
sary and  1  month's  night  duty) 5 

Children 4 

Maternity 3 

Social  service  or  visiting  nursing 2 

Mental 2 

Vacation 2 

28 

Scheme  Number  4 
Credit  of  full  calendar  year.    Period  of  training  covers  2J+  months 

Preparatory 3 

Medical 4 

Surgical 4 

Children 3 

Maternity 3 

Operating  room  or  surgical  dispensary,  choice  of  1^  months ^  „ 

Social  service  or  medical  or  children's  dispensary,  choice  of  1£  months. .  / 

Night  duty 2 

Vacation 2 

24 


APPENDIX  VI 

Hour  Schedules  from  Hospitals  in  which  an  Eight  Hour  Day 
is  in  Operation 

No.  1  8  hour  day 

10  hour  night 

Day,  7.30  a.m.  to  9.30  p.m 14  hours  to  cover 

Night,  9.30  p.m.  to  7.30  a.m 10  hours  to  cover 

Hours  on  duty 

a.m.  p.m. 

7.30 4 

7.30-10.30  4-9.30 

7.30-1  4-7.30 

7.30-2.30  6-7.30 

7.30-12  4-8 

7.30-10.30  12.30-6  (occasionally) 

$  hour  allowed  for  meals 
No.  2  8  hour  ddy 

10  hour  night 

Day,  7  a.m.  to  9  p.m 14  hours  to  cover 

Night,  9  p.m.  to  7  a.m 10  hours  to  cover 

Hours  on  duty 

a.m.  p.m. 

7-9  1-7 

7-1  7-9 

7-1  5^-7 

7-11  3-7 

7-12  1-4 

7-12  5-6    off    7-9 

1  hour  allowed  for  meals. 
^  day  on  Sunday  and  usually  on  holidays. 
No.  3  8-hour  system. 

Day,       7  a.m.  to  11  p.m 16  hours  to  cover 

Night,  11  p.m.  to  7  a.m 8  hours  to  cover 

Large  ward  of  60  patients,  some  in  private  rooms. 


Hours  on  duty 
1  senior 

a.m. 

7 

p.m 
to         3 

1  intermediate 

7 

to         3 

1  intermediate 

7-12 

3-7 

1  Junior 

7-11 

4-7 

1  junior 
2  probationers 

7-1 
7-1 

5-7 
5-7 

At  S  p.m..     a  senior  head-nurse  comes  on  with  2  junior  assistants  who  work 
through  until  11  p.m. 

175 


176  APPENDIX   VI 

At  11  p.m.    a  night  head-nurse  comes  on  with  2  juniors  who  take  the  floor 

until  the  day  nurses  report. 

In  operating  rooms,   diet  kitchens  and  contagious  wards  the 
service  is  10  hours  with  half-days. 
Half-days  also  are  given  weekly  and  Sundays. 
No.  4.  8-hour  system  three  shifts 

Day,        7  a.m.      to      3  p.m 8  hours  to  cover 

3. p.m.      to    11  p.m 8  hours  to  cover 

11. p.m.      to      7.a.m 8  hours  to  cover 

Hours  on  duty 

a.m..  p.m. 

7-1  4.30-7 

7-10.30  2-7 

7-2  5-7 

7  3.30  off  for  day. 

At  3  p.m.      a  night  nurse  comes  on  and  stays  until  11  p.m. 
At  11  p.m..  another  night  nurse  comes  on  and  stays  until  7  a.m. 

From  7  a.m.  a  nurse  may  be  on  duty  in  accordance  with  needs 
and  off  from  12  midnight  to  4  a.m. 

£  days  off  on  holidays  and  Sundays. 

1  hour  for  meals. 
No.  5  8  hour  day 

12  hour  night. 

Day,     7  a.m.  to  7  p.m 12  hours  to  cover 

Night,  7  p.m.  to  7  a.m 12  hours  to  cover 

Ward.  30  beds. 

4  students 
Hours  on  duty 

a.m..          p.m. 

7-11  1-5 

7-12  4-7 

7-1  2-4 

7-1  5-7 


APPENDIX  VII 

Suggested  Basis  of  Credit  for  Nursing  Schools 

A  number  of  nursing  schools  are  already  connected  with  universities,  and 
many  more  are  planning  their  work  more  or  less  on  the  credit  basis  of  the 
higher  technical  schools  and  colleges.  Such  a  system  makes  it  more  possible 
for  other  educational  institutions  to  interpret  and  accredit  the  work  done  in 
nursing  schools  and  also  provides  a  basis  of  comparison  between  the  work  of 
one  nursing  school  and  another. 

The  system  of  credits  used  by  most  colleges  and  technical  schools  is  on  the 
basis  of  the  term's  work1 — a  term  representing  a  period  of  approximately  15 
weeks.  For  1  hour  of  lecture  or  class  per  week  during  one  term  (or  15  hours), 
the  student  would  receive  1  point  or  1  credit.  (This  would  presuppose  2  hours 
of  outside  preparation  for  every  hour  of  class  or  lecture  work.)  About  2  to 
3  hours  of  laboratory  or  class-room  practice  is  usually  credited  as  equal  to  1 
hour  of  regular  class  or  lecture  work. 

On  this  basis  the  theoretical  work  of  the  nursing  school  could  be  evaluated 
easily,  the  subjects  covered  in  this  curriculum  amounting  to  about  36  points, 
or  one  college  year  of  work.  It  is  much  more  difficult  to  arrive  at  a  satisfactory 
system  of  accrediting  the  practical  work.  Valuable  as  we  feel  this  to  be,  we 
cannot  claim  that  it  is  of  such  intensive  educational  value,  hour  for  hour,  as 
organized  class  or  laboratory  work  which  progresses  steadily  from  one  new 
project  to  another  and  which  is  under  constant  supervision  and  criticism  by 
the  teacher. 

It  must  be  understood  that  the  work  of  vocational  schools,  such  as  music 
or  art  schools,  is  not  usually  allowed  full  academic  credit  even  in  the  most 
liberal  colleges.  The  maximum  of  academic  credit  .which  would  probably  be 
allowed  for  practical  work  of  the  type  represented  by  nursing  schools,  would 
be  at  the  rate  of  from  1  to  1J  points  per  month.  There  is  no  accepted  basis 
however  for  accrediting  practical  work. 

It  is  suggested  that  nursing  schools  with  university  affiliations  should  ar- 
range all  their  theoretical  work  on  the  credit  basis.  This  would  mean  some 
adjustment  of  the  course  of  study  as  outlined  here.  All  10-hour  courses  should 
be  raised  to  15  hours,  so  that  they  may  qualify  as  1-point  courses;  all  20-hour 
courses  should  be  raised  to  30  hours  (or  where  laboratory  work  is  included,  to 
45  hours),  to  count  as  2-point  courses,  etc.  Examination  periods  would  be  in- 
eluded  in  the  15  or  30  hours.  This  increase  would  mean  6  hours  of  class  and 
lecture  work  a  week  (after  the  first  year),  instead  of  4  hours,  which  was  con- 
sidered the  minimum  for  the  average  school.  Several  schools  are  already 
working  on  this  basis. 

Many  universities  refuse  to  credit  any  courses  of  less  than  30  hours  or  2 
points,  hence  it  would  be  well  where  possible  to  combine  two  or  more  closely 
related  short  courses  into  one  which  would  represent  at  least  two  points 
of  credit. 

177 


I 

JAN  2      1930 


JUl    R 


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MAY  1  1  1939 
JAN  9    mi 
JUL  5     1949 

219$ 

JUL  2  6  194S 
OCT  4    1950 

MAR     1  1953 

OCT  5      1954 


Form  L-9-lTi/ii-l  l.'"7 


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